MEDICARE: JEFFREY F. DESIMONE

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	332H00000X	Eyewear Supplier	OEG1767	PA

General Provider Information

NPI Number	:	1720258684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY F. DESIMONE

Provider Business Mailing Address
First Line	:	2 E MAITLAND LN
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1248
Country	:	US
Telephone Number	:	724-658-4700
Fax Number	:	724-658-5686

Provider Business Practice Location Address
First Line	:	2 E MAITLAND LN
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1248
Country	:	US
Telephone Number	:	724-658-4700
Fax Number	:	724-658-5686

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY F DESIMONE
Credential	:	O.D.
Telephone Number	:	724-658-4700

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	09/11/2012

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