Provider Demographics
NPI:1700898830
Name:MENZEL, JOHN P (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MENZEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:141 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-825-3491
Practice Address - Fax:570-822-5654
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410034667OtherRAILROAD MEDICARE
072089OtherFIRST PRIORITY HEALTH
ME078262OtherHIGH MARK BLUE SHIELD
OEG001358OtherLICENSE
18730OtherGEISINGER HEALTH PLAN
506550OtherAETNA