Provider Demographics
NPI:1568505428
Name:DIGIOVANNI OPTICAL CORP
Entity Type:Organization
Organization Name:DIGIOVANNI OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIGIOVANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-465-6900
Mailing Address - Street 1:2130 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3952
Mailing Address - Country:US
Mailing Address - Phone:215-465-6900
Mailing Address - Fax:215-551-6970
Practice Address - Street 1:2130 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3952
Practice Address - Country:US
Practice Address - Phone:215-465-6900
Practice Address - Fax:215-551-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA05-01265074Medicaid