Provider Demographics
NPI:1336116409
Name:HERMAN, JOHN P (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:HERMAN
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 1:217 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6837
Mailing Address - Country:US
Mailing Address - Phone:413-499-3797
Mailing Address - Fax:413-499-3834
Practice Address - Street 1:217 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6837
Practice Address - Country:US
Practice Address - Phone:413-499-3797
Practice Address - Fax:413-499-3834
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2415152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0321133Medicaid
MA0321133Medicaid
MAHE136258Medicare ID - Type Unspecified