=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922338433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIANA J DONCH OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2010
-----------------------------------------------------
Last Update Date | 11/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146 W ADAMS ST
-----------------------------------------------------
City | COCHRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16314-8640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-425-3937
-----------------------------------------------------
Fax | 814-425-3378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 W ADAMS ST PO BOX 392
-----------------------------------------------------
City | COCHRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16314-8640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-425-3937
-----------------------------------------------------
Fax | 814-425-3378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DIANA JO DONCH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 814-425-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG000457
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------