MEDICARE: JEFFREY F DESIMONE OD

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	OEG001767	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410006252	OTHER	PA	MEDICARE RR

Other Identifiers

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

General Provider Information

NPI Number	:	1982600243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY F DESIMONE OD

Provider Business Mailing Address
First Line	:	2 E MAITLAND LN
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1248
Country	:	US
Telephone Number	:	724-658-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 E MAITLAND LN
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1248
Country	:	US
Telephone Number	:	724-658-4700
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/24/2012

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