Provider Demographics
NPI:1407814643
Name:JOHN J MARTINELLI OD LTD
Entity Type:Organization
Organization Name:JOHN J MARTINELLI OD LTD
Other - Org Name:MARTINELLI EYE AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-483-3675
Mailing Address - Street 1:303 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-1427
Mailing Address - Country:US
Mailing Address - Phone:724-483-3675
Mailing Address - Fax:
Practice Address - Street 1:303 1ST ST
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1427
Practice Address - Country:US
Practice Address - Phone:724-483-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004240L152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU07932Medicare UPIN
PA0793870001Medicare NSC