Provider Demographics
NPI:1275808347
Name:DAVID J KAIRYS ODPC
Entity Type:Organization
Organization Name:DAVID J KAIRYS ODPC
Other - Org Name:PROFESSIONAL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAIRYS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-371-2211
Mailing Address - Street 1:5522 SHAFFER RD UNIT 127
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3319
Mailing Address - Country:US
Mailing Address - Phone:814-371-2211
Mailing Address - Fax:814-371-5015
Practice Address - Street 1:5522 SHAFFER RD UNIT 127
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3319
Practice Address - Country:US
Practice Address - Phone:814-371-2211
Practice Address - Fax:814-371-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA26109OtherOPTUMHEALTH
PA52270OtherDAVIS
PA8143712211OtherVSP
PA911047OtherEYEMED
PA0012992050003Medicaid
PA05522OtherVBA
PA0012992050003Medicaid
PAT30164Medicare UPIN