Provider Demographics
NPI:1285690495
Name:PYLE, DEREK J (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:J
Last Name:PYLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 PLAZA COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8260
Mailing Address - Country:US
Mailing Address - Phone:570-421-8842
Mailing Address - Fax:570-476-5842
Practice Address - Street 1:300 PLAZA COURT
Practice Address - Street 2:SUITE A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8260
Practice Address - Country:US
Practice Address - Phone:570-421-8842
Practice Address - Fax:570-476-5842
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014751900001Medicaid
PA1014751900001Medicaid
087081F88Medicare ID - Type Unspecified