Provider Demographics
NPI:1003976663
Name:PIANTONI, DOMINICK B (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:B
Last Name:PIANTONI
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4110
Mailing Address - Country:US
Mailing Address - Phone:609-890-2110
Mailing Address - Fax:609-890-0987
Practice Address - Street 1:2660 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-4110
Practice Address - Country:US
Practice Address - Phone:609-890-2110
Practice Address - Fax:609-890-0987
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1095156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0776310001Medicare NSC