Healthcare Provider Details

I. General information

NPI: 1922338433
Provider Name (Legal Business Name): DIANA J DONCH OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W ADAMS ST
COCHRANTON PA
16314-8640
US

IV. Provider business mailing address

146 W ADAMS ST PO BOX 392
COCHRANTON PA
16314-8640
US

V. Phone/Fax

Practice location:
  • Phone: 814-425-3937
  • Fax: 814-425-3378
Mailing address:
  • Phone: 814-425-3937
  • Fax: 814-425-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000457
License Number StatePA

VIII. Authorized Official

Name: DIANA JO DONCH
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 814-425-3937