Provider Demographics
NPI:1770580623
Name:RHOADES, JAMES T (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:RHOADES
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 1:500 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15461-1778
Mailing Address - Country:US
Mailing Address - Phone:724-583-8338
Mailing Address - Fax:724-583-7037
Practice Address - Street 1:500 N WATER ST
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-1778
Practice Address - Country:US
Practice Address - Phone:724-583-8338
Practice Address - Fax:724-583-7037
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0E005416-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018508090001Medicaid
PA016736OtherMEDICARE PTAN
PA1745OtherDAVIS VISION
NVA390514OtherNATIONAL VISION ASSOC.
PA16736OtherCLARITY VISION
PA1745OtherDAVIS VISION