Provider Demographics
NPI:1275517385
Name:IAMELE, JOHN D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:IAMELE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2955
Mailing Address - Country:US
Mailing Address - Phone:631-385-2020
Mailing Address - Fax:631-385-5688
Practice Address - Street 1:164 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2955
Practice Address - Country:US
Practice Address - Phone:631-385-2020
Practice Address - Fax:631-385-5688
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1275517385OtherINDIVIDUAL NPI
NY1760539159OtherBUSINESS NPI
NY1760539159OtherBUSINESS NPI
NYC33541Medicare PIN
NY5088400001Medicare NSC