Provider Demographics
NPI:1235195793
Name:ROMIG, DENNIS GINO (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GINO
Last Name:ROMIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:GINO
Other - Last Name:ROMIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PC
Mailing Address - Street 1:1202 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102
Mailing Address - Country:US
Mailing Address - Phone:610-433-3990
Mailing Address - Fax:610-433-3990
Practice Address - Street 1:1202 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-433-3990
Practice Address - Fax:610-433-3990
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004629T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
232634573OtherTAX ID
PA00548478Medicaid
PA00548478Medicaid
R0288861Medicare ID - Type Unspecified
232634573OtherTAX ID