Healthcare Provider Details

I. General information

NPI: 1720495864
Provider Name (Legal Business Name): JAMES DEOM O.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 AIRPORT RD
HAZLE TOWNSHIP PA
18202-3320
US

IV. Provider business mailing address

180 KNORR RD
DRUMS PA
18222-3015
US

V. Phone/Fax

Practice location:
  • Phone: 570-453-2020
  • Fax:
Mailing address:
  • Phone: 570-436-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002986
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG002986
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: