Provider Demographics
NPI:1730142134
Name:KAIRYS, DAVID JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:KAIRYS
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 1:5522 SHAFFER RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3315
Mailing Address - Country:US
Mailing Address - Phone:814-371-2210
Mailing Address - Fax:814-371-5015
Practice Address - Street 1:5522 SHAFFER RD
Practice Address - Street 2:SUITE 127
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3315
Practice Address - Country:US
Practice Address - Phone:814-371-2210
Practice Address - Fax:814-371-5015
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0E-005656P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPV26109OtherSPECTERA
PA911047OtherEYEMED
PA52270OtherDAVIS
PAPA05522OtherVBA
PWKA401335Medicaid
ORPV26109OtherSPECTERA
PWKA401335Medicaid