Provider Demographics
NPI:1285646307
Name:CIMOCHOWSKI, JOSEPH F (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:CIMOCHOWSKI
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 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:200 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-342-3145
Practice Address - Fax:570-344-1309
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
072544OtherFIRST PRIORITY HEALTH
PA001156220Medicaid
20968OtherGEISINGER HEALTH PLAN
506554OtherAETNA
CI060799OtherHIGH MARK BLUE SHIELD
182939040OtherRAILROAD MEDICARE
506554OtherAETNA
CI060799OtherHIGH MARK BLUE SHIELD