=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578546545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD B DIDONATO OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 09/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 WHITEHORSE HAMILTON SQUARE RD
-----------------------------------------------------
City | HAMILTON SQUARE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-587-2020
-----------------------------------------------------
Fax | 609-588-9545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 WHITEHORSE HAMILTON SQUARE RD
-----------------------------------------------------
City | HAMILTON SQUARE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-587-2020
-----------------------------------------------------
Fax | 609-588-9545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0A04122
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | TO 00027
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 156F00000X
-----------------------------------------------------
Taxonomy Name | Technician/Technologist
-----------------------------------------------------
License Number | 27TO00002700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------