Provider Demographics
NPI:1295773471
Name:MCAVOY, JAMES P (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:MCAVOY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201A NORTH CHURCH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1443
Mailing Address - Country:US
Mailing Address - Phone:570-454-6302
Mailing Address - Fax:570-454-3564
Practice Address - Street 1:1201A NORTH CHURCH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1443
Practice Address - Country:US
Practice Address - Phone:570-454-6302
Practice Address - Fax:570-454-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076389Medicaid
PA076389Medicaid
PA096270K9EMedicare PIN