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General NPI Number Information
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NPI Number | 1720258684
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Entity Type | Organization
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Legal Business Name | JEFFREY F. DESIMONE
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 2 E MAITLAND LN
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City | NEW CASTLE
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State | PA
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Zip | 16105-1248
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Country | US
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Telephone | 724-658-4700
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Fax | 724-658-5686
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Provider Business Mailing Address
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Address Line | 2 E MAITLAND LN
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City | NEW CASTLE
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State | PA
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Zip | 16105-1248
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Country | US
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Telephone | 724-658-4700
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Fax | 724-658-5686
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY F DESIMONE
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Credential | O.D.
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Telephone | 724-658-4700
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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 | OEG1767
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License Number State | PA
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