Provider Demographics
NPI:1184769713
Name:DUFFY, JOHN LAWRENCE (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LAWRENCE
Last Name:DUFFY
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 1:1211 W. LANCASTER AVE.
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-525-2580
Mailing Address - Fax:610-525-2705
Practice Address - Street 1:1211 W. LANCASTER AVE.
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-525-2580
Practice Address - Fax:610-525-2705
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist