Provider Demographics
NPI:1558497610
Name:MESSNER, JOEL D (OD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:MESSNER
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 1:12280 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1820
Mailing Address - Country:US
Mailing Address - Phone:724-863-2000
Mailing Address - Fax:724-863-3599
Practice Address - Street 1:12280 ROUTE 30
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1820
Practice Address - Country:US
Practice Address - Phone:724-863-2000
Practice Address - Fax:724-863-3599
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000880604Medicaid
PA0601700001Medicare NSC
PA033840Medicare PIN
PAT27210Medicare UPIN