| Michele L Domiano Od Pc | |
|
189 North Main Street, Old Forge, PA 18518-1755 | |
| (570) 451-2020 | |
| (570) 451-3083 |
| Full Name | Michele L Domiano Od Pc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 189 North Main Street, Old Forge, Pennsylvania |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659531721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | MD0417368 (Pennsylvania) | Secondary |
| 152W00000X | Optometrist | OE007704T (Pennsylvania) | Secondary |
| 152W00000X | Optometrist | OEG000869 (Pennsylvania) | Primary |
| Provider Name | Michele L Domiano |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265406730 PECOS PAC ID: 2961579982 Enrollment ID: I20081114000539 |
| Mailing Address | Practice Location Address |
|---|---|
| Michele L Domiano Od Pc 189 North Main Street, Old Forge, PA 18518-1755 Ph: (570) 451-2020 | Michele L Domiano Od Pc 189 North Main Street, Old Forge, PA 18518-1755 Ph: (570) 451-2020 |
Dr. Michele L Domiano, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 189 N Main St, Old Forge, PA 18518 Phone: 570-451-2020 Fax: 570-451-3083 | |
Ben Domiano Optical Center Llc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 817 S Main St, Old Forge, PA 18518 Phone: 570-457-2020 Fax: 570-457-2787 |