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NPI Code Detail

MEDICARE: DR. ANTHONY DIMAGGIO O.D.

MEDICARE: DR. ANTHONY DIMAGGIO 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
1152W00000XOptometrist1282-438TLA

General Provider Information

NPI Number : 1295760635
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY DIMAGGIO O.D.
Provider Business Mailing Address
First Line : 1299 HIGHWAY 3226
Second Line :
City : DERIDDER
State : LA
Zip : 70634-9133
Country : US
Telephone Number : 337-463-6169
Fax Number :
Provider Business Practice Location Address
First Line : 2204 S 5TH ST
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-5318
Country : US
Telephone Number : 337-238-9819
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/08/2007

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