Provider Demographics
NPI:1336232628
Name:JANIDLO, HEATHER KERR (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KERR
Last Name:JANIDLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DYAN
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W PENN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1223
Mailing Address - Country:US
Mailing Address - Phone:814-623-5018
Mailing Address - Fax:814-623-7718
Practice Address - Street 1:120 W PENN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE1726724OtherHIGHMARK BLUE SHIELD
PA090425Medicare ID - Type Unspecified