Provider Demographics
NPI:1811953292
Name:KARDOS, JOHN T (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:KARDOS
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14625 MOUNT AIRY RD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1431
Practice Address - Country:US
Practice Address - Phone:717-227-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2792152W00000X
DEI3-0001414152W00000X
PAOE6897P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA289321OtherMAMSI PROVIDER NUMBER
MD52450901OtherMARYLAND PROVIDER NUMBER
PA5204517OtherAETNA NUMBER
PA396758OtherNVA IDENTIFIER
PA538644Medicaid
MD52450901OtherMARYLAND PROVIDER NUMBER
PA289321OtherMAMSI PROVIDER NUMBER
PA538644Medicaid