Healthcare Provider Details

I. General information

NPI: 1174521371
Provider Name (Legal Business Name): NICHOLAS DROBNY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EAST ST
BLOOMSBURG PA
17815-1846
US

IV. Provider business mailing address

301 EAST ST
BLOOMSBURG PA
17815-1846
US

V. Phone/Fax

Practice location:
  • Phone: 570-387-8800
  • Fax: 570-784-8887
Mailing address:
  • Phone: 570-387-8800
  • Fax: 570-784-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: