Provider Demographics
NPI:1982701538
Name:WAY, RICHARD O JR (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:O
Last Name:WAY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:128 LAYTON LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-4018
Mailing Address - Country:US
Mailing Address - Phone:814-269-3937
Mailing Address - Fax:814-266-5431
Practice Address - Street 1:150 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2844
Practice Address - Country:US
Practice Address - Phone:814-269-3937
Practice Address - Fax:814-266-5431
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET-008942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0071534040002Medicaid
PA441312Medicare ID - Type Unspecified
PA0071534040002Medicaid