Healthcare Provider Details

I. General information

NPI: 1831369669
Provider Name (Legal Business Name): JOHN P. BOSCIA, OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SULLIVAN TRL
EASTON PA
18040-8354
US

IV. Provider business mailing address

2020 SULLIVAN TRL
EASTON PA
18040-8354
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-6666
  • Fax:
Mailing address:
  • Phone: 610-258-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOEG000704
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOHN PAUL BOSCIA
Title or Position: OWNER
Credential: OD
Phone: 610-258-6666