MEDICARE: PAUL CLAY DIMON OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1386899474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL CLAY DIMON OPTICIAN

Provider Business Mailing Address
First Line	:	608 E GRAND AVE
Second Line	:
City	:	TOWER CITY
State	:	PA
Zip	:	17980
Country	:	US
Telephone Number	:	717-647-9005
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 E GRAND AVE
Second Line	:	WILLIAMS VALLEY OPT.
City	:	TOWER CITY
State	:	PA
Zip	:	17980
Country	:	US
Telephone Number	:	717-647-9005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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