Provider Demographics
NPI:1528029105
Name:DIMINO, WILLIAM JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:DIMINO
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 1:503 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4231
Mailing Address - Country:US
Mailing Address - Phone:610-313-3191
Mailing Address - Fax:610-313-3193
Practice Address - Street 1:503 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-4231
Practice Address - Country:US
Practice Address - Phone:610-313-3191
Practice Address - Fax:610-313-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU02255Medicare UPIN
PA5701530001Medicare NSC
PA619165Medicare ID - Type Unspecified