Healthcare Provider Details

I. General information

NPI: 1871507590
Provider Name (Legal Business Name): NICHOLAS F. DARBENZIO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAIN ST
DUPONT PA
18641-1448
US

IV. Provider business mailing address

406 PENN AVE
DUPONT PA
18641-2020
US

V. Phone/Fax

Practice location:
  • Phone: 570-602-9607
  • Fax:
Mailing address:
  • Phone: 570-602-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000120
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: