Provider Demographics
NPI:1689949067
Name:RICHARD L JAHNLE MD PC
Entity Type:Organization
Organization Name:RICHARD L JAHNLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAHNLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-446-2260
Mailing Address - Street 1:2010 W CHESTER PIKE
Mailing Address - Street 2:WELLNESS CENTER; SUITE 310
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2737
Mailing Address - Country:US
Mailing Address - Phone:610-446-2260
Mailing Address - Fax:610-446-3360
Practice Address - Street 1:2010 W CHESTER PIKE
Practice Address - Street 2:WELLNESS CENTER; SUITE 310
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2737
Practice Address - Country:US
Practice Address - Phone:610-446-2260
Practice Address - Fax:610-446-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA238200Medicare PIN