Provider Demographics
NPI:1619077195
Name:PINELLI, RICHARD JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:PINELLI
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 1:23428 ROUTE 35 N
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-7916
Mailing Address - Country:US
Mailing Address - Phone:717-436-8806
Mailing Address - Fax:
Practice Address - Street 1:23428 ROUTE 35 N
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-7916
Practice Address - Country:US
Practice Address - Phone:717-436-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000702152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA562783OtherBLUE SHIELD
PA0626460001Medicare NSC
PAT87944Medicare UPIN
PA562783OtherBLUE SHIELD