Provider Demographics
NPI:1538169073
Name:JOHN A REIMOLD JR OD PC
Entity type:Organization
Organization Name:JOHN A REIMOLD JR OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REIMOLD
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:724-588-3322
Mailing Address - Street 1:59 HADLEY RD
Mailing Address - Street 2:STE A
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1219
Mailing Address - Country:US
Mailing Address - Phone:724-588-3322
Mailing Address - Fax:724-588-3552
Practice Address - Street 1:59 HADLEY RD
Practice Address - Street 2:STE A
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1219
Practice Address - Country:US
Practice Address - Phone:724-588-3322
Practice Address - Fax:724-588-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA306291OtherUPMC HEALTH PLAN
PA1567182OtherHIGHMARK BC/BS
076511Medicare ID - Type Unspecified
PA306291OtherUPMC HEALTH PLAN
PA5117150001Medicare NSC