Provider Demographics
NPI:1306813407
Name:PETRAS, PAUL J (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:PETRAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3035
Mailing Address - Country:US
Mailing Address - Phone:724-465-6531
Mailing Address - Fax:724-465-6531
Practice Address - Street 1:535 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3035
Practice Address - Country:US
Practice Address - Phone:724-465-6531
Practice Address - Fax:724-465-6531
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-4706-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08071Medicare UPIN