Provider Demographics
NPI:1538265319
Name:JASKIEWICZ, DAVID WALTER (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WALTER
Last Name:JASKIEWICZ
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 1:340 PINKERTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8678
Mailing Address - Country:US
Mailing Address - Phone:724-934-1664
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 18
Practice Address - Street 2:WALMART PLAZA
Practice Address - City:MONAGA
Practice Address - State:PA
Practice Address - Zip Code:15061
Practice Address - Country:US
Practice Address - Phone:724-773-2930
Practice Address - Fax:724-773-2932
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
441677OtherBC
441677OtherBC