Provider Demographics
NPI:1730678251
Name:AENTARA, JOSEPH ARIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ARIEL
Last Name:AENTARA
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 1:3068 CLOVERLY DR
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1231
Mailing Address - Country:US
Mailing Address - Phone:215-489-9815
Mailing Address - Fax:
Practice Address - Street 1:3068 CLOVERLY DR
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1231
Practice Address - Country:US
Practice Address - Phone:215-489-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008143152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy