Provider Demographics
NPI:1255841565
Name:JANIDLO OPTOMETRY PC
Entity Type:Organization
Organization Name:JANIDLO OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:KERR
Authorized Official - Last Name:JANIDLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-423-2030
Mailing Address - Street 1:120 W PENN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1223
Mailing Address - Country:US
Mailing Address - Phone:814-623-5018
Mailing Address - Fax:814-623-7718
Practice Address - Street 1:120 W PENN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1223
Practice Address - Country:US
Practice Address - Phone:814-623-5018
Practice Address - Fax:814-623-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center