Provider Demographics
NPI:1811987555
Name:MEEHAN, JAMES ELTON (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ELTON
Last Name:MEEHAN
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 1:104 CHEROKEE CT
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16229-2424
Mailing Address - Country:US
Mailing Address - Phone:724-295-4301
Mailing Address - Fax:
Practice Address - Street 1:249 ARCH ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-1514
Practice Address - Country:US
Practice Address - Phone:724-548-5146
Practice Address - Fax:724-545-2117
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001272730003Medicaid
PA690786Medicare ID - Type Unspecified
PA001272730003Medicaid