MEDICARE: RICHARD JOSEPH SANTASANIA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000257	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053350546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JOSEPH SANTASANIA O.D.

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:
City	:	POCONO SUMMIT
State	:	PA
Zip	:	18346-0127
Country	:	US
Telephone Number	:	570-839-5746
Fax Number	:	570-839-5748

Provider Business Practice Location Address
First Line	:	HC 89
Second Line	:
City	:	POCONO SUMMIT
State	:	PA
Zip	:	18346-9801
Country	:	US
Telephone Number	:	570-839-5746
Fax Number	:	579-839-5748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	10/31/2010

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