Provider Demographics
NPI:1083828628
Name:STEPHEN G. DIAMANTONI, MD AND ASSOCIATES FAMILY PRACTICE
Entity Type:Organization
Organization Name:STEPHEN G. DIAMANTONI, MD AND ASSOCIATES FAMILY PRACTICE
Other - Org Name:DIAMANTONI & ASSOCIATES OPTOMETRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-295-2323
Mailing Address - Street 1:319 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4930
Mailing Address - Country:US
Mailing Address - Phone:717-396-0680
Mailing Address - Fax:
Practice Address - Street 1:319 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4930
Practice Address - Country:US
Practice Address - Phone:717-396-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN G. DIAMANTONI, MD AND ASSOCIATES FAMILY PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158841Medicare PIN