Provider Demographics
NPI:1417055260
Name:JANNEY, JOHN D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:JANNEY
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 1:201 JONES AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2906
Mailing Address - Country:US
Mailing Address - Phone:304-469-2020
Mailing Address - Fax:
Practice Address - Street 1:201 JONES AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2906
Practice Address - Country:US
Practice Address - Phone:304-469-2020
Practice Address - Fax:304-469-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV556-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149468000Medicaid
WVT32477Medicare UPIN
WV0149468000Medicaid