Provider Demographics
NPI:1366628950
Name:JAMES T. RHOADES
Entity Type:Organization
Organization Name:JAMES T. RHOADES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-583-8338
Mailing Address - Street 1:500 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15461-1778
Mailing Address - Country:US
Mailing Address - Phone:724-583-8338
Mailing Address - Fax:724-583-7037
Practice Address - Street 1:500 N WATER ST
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-1778
Practice Address - Country:US
Practice Address - Phone:724-583-8338
Practice Address - Fax:724-583-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05416152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0283590001Medicare NSC