Provider Demographics
NPI:1932180965
Name:MARTINELLI, JOHN J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:MARTINELLI
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:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-0526
Mailing Address - Country:US
Mailing Address - Phone:724-483-3675
Mailing Address - Fax:
Practice Address - Street 1:303 1ST ST
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1427
Practice Address - Country:US
Practice Address - Phone:724-483-3675
Practice Address - Fax:724-483-0404
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEP008552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010361420001Medicaid
PA0010361420001Medicaid
PA285565Q7NMedicare ID - Type Unspecified