Provider Demographics
NPI:1922140656
Name:DESPOY, JAMES A
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:DESPOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MAGEE AVE
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-1210
Mailing Address - Country:US
Mailing Address - Phone:814-674-8922
Mailing Address - Fax:814-674-5818
Practice Address - Street 1:401 MAGEE AVE
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:PA
Practice Address - Zip Code:16668-1210
Practice Address - Country:US
Practice Address - Phone:814-674-8922
Practice Address - Fax:814-674-5818
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013113850001Medicaid