Provider Demographics
NPI:1043864283
Name:CIOCOTISAN, IOAN (OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:IOAN
Middle Name:
Last Name:CIOCOTISAN
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARK LN
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1509
Mailing Address - Country:US
Mailing Address - Phone:609-751-6280
Mailing Address - Fax:
Practice Address - Street 1:550 E LANCASTER AVE STE C1
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5044
Practice Address - Country:US
Practice Address - Phone:610-687-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty