Provider Demographics
NPI:1053362657
Name:BISSELL, JOHN DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:BISSELL
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 1:5900 HECKERT RD
Mailing Address - Street 2:P.O. BOX 324
Mailing Address - City:BAKERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15007-1002
Mailing Address - Country:US
Mailing Address - Phone:724-443-6767
Mailing Address - Fax:724-443-6730
Practice Address - Street 1:5900 HECKERT RD
Practice Address - Street 2:
Practice Address - City:BAKERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15007-1002
Practice Address - Country:US
Practice Address - Phone:724-443-6767
Practice Address - Fax:724-443-6730
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV00619Medicare UPIN
PA081329QQTMedicare ID - Type Unspecified