Provider Demographics
NPI:1366442808
Name:REIMOLD, JOHN ALLEN JR (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:REIMOLD
Suffix:JR
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 1:59 HADLEY RD
Mailing Address - Street 2:STE A
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1219
Mailing Address - Country:US
Mailing Address - Phone:724-588-3322
Mailing Address - Fax:724-588-3552
Practice Address - Street 1:59 HADLEY RD
Practice Address - Street 2:STE A
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1219
Practice Address - Country:US
Practice Address - Phone:724-588-3322
Practice Address - Fax:724-588-3552
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29453Medicare UPIN
PA134489SGUMedicare ID - Type Unspecified