Provider Demographics
NPI:1891724456
Name:ASTORINO, JEAN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANN
Last Name:ASTORINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E STATE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-892-8767
Mailing Address - Fax:610-892-2991
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-892-8767
Practice Address - Fax:610-892-2991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001313152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0846745000OtherKEYSTONE
PA817167OtherBLUE SHIELD
PA3817331OtherAETNA
PA817167TZ1Medicare ID - Type Unspecified
PAU61399Medicare UPIN