MEDICARE: DIGIOVANNI OPTICAL CORP

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	332H00000X	Eyewear Supplier

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	:	1568505428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGIOVANNI OPTICAL CORP

Provider Business Mailing Address
First Line	:	2130 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3952
Country	:	US
Telephone Number	:	215-465-6900
Fax Number	:	215-551-6970

Provider Business Practice Location Address
First Line	:	2130 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3952
Country	:	US
Telephone Number	:	215-465-6900
Fax Number	:	215-551-6970

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. PAUL G DIGIOVANNI
Credential	:
Telephone Number	:	215-465-6900

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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Directions to “DIGIOVANNI OPTICAL CORP ” Practice Location

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