1255564415 NPI number — MR. GEORGE JOSEPH DIMARTINO DISPENSING OPTICIAN

Table of content: MR. GEORGE JOSEPH DIMARTINO DISPENSING OPTICIAN (NPI 1255564415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255564415 NPI number — MR. GEORGE JOSEPH DIMARTINO DISPENSING OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMARTINO
Provider First Name:
GEORGE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DISPENSING OPTICIAN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255564415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 SMOKY PARK HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28806-1166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-667-3211
Provider Business Mailing Address Fax Number:
828-670-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 SMOKY PARK HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28806-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-667-3211
Provider Business Practice Location Address Fax Number:
828-670-1120
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  967 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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