Provider Demographics
NPI:1073656948
Name:DIGIOVANNI OPTICAL LAB, LLC
Entity Type:Organization
Organization Name:DIGIOVANNI OPTICAL LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIGIOVANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-931-0063
Mailing Address - Street 1:206 N BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1630
Mailing Address - Country:US
Mailing Address - Phone:856-931-0063
Mailing Address - Fax:856-939-0602
Practice Address - Street 1:206 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1630
Practice Address - Country:US
Practice Address - Phone:856-931-0063
Practice Address - Fax:856-939-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier