Provider Demographics
NPI:1598742512
Name:O'BRYON, JAMES E (OD, MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:O'BRYON
Suffix:
Gender:M
Credentials:OD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2512
Mailing Address - Country:US
Mailing Address - Phone:814-371-3980
Mailing Address - Fax:814-371-8317
Practice Address - Street 1:898 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2512
Practice Address - Country:US
Practice Address - Phone:814-371-3980
Practice Address - Fax:814-371-8317
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000605152W00000X
PAMD428662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009964680007Medicaid
PAI49509Medicare UPIN
PA110310Medicare PIN