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General NPI Number Information
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NPI Number | 1073656948
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Entity Type | Organization
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Legal Business Name | DIGIOVANNI OPTICAL LAB, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 206 N BLACK HORSE PIKE
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City | RUNNEMEDE
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State | NJ
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Zip | 08078-1630
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Country | US
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Telephone | 856-931-0063
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Fax | 856-939-0602
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Provider Business Mailing Address
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Address Line | 206 N BLACK HORSE PIKE
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City | RUNNEMEDE
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State | NJ
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Zip | 08078-1630
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Country | US
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Telephone | 856-931-0063
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Fax | 856-939-0602
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. PAUL G DIGIOVANNI
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Credential |
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Telephone | 856-931-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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