Provider Demographics
NPI:1164401824
Name:DENICK, DENNIS J (OD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:DENICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1842
Mailing Address - Country:US
Mailing Address - Phone:610-277-0720
Mailing Address - Fax:
Practice Address - Street 1:2668 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1842
Practice Address - Country:US
Practice Address - Phone:610-277-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
439943UAXMedicare ID - Type Unspecified
U58568Medicare UPIN