Provider Demographics
NPI:1578546545
Name:DIDONATO, EDWARD B (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:DIDONATO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:E
Other - Middle Name:BRUCE
Other - Last Name:DIDONATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3536
Mailing Address - Country:US
Mailing Address - Phone:609-587-2020
Mailing Address - Fax:609-588-9545
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-587-2020
Practice Address - Fax:609-588-9545
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0A04122152W00000X
NJTO 00027152WC0802X
332H00000X
NJ27TO00002700156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No332H00000XSuppliersEyewear Supplier
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0887782006OtherCIGNA
25428OtherMASTERCARE
0071821000OtherAMERIHEALTH
1339341OtherUNITED HEALTHCARE
2451818OtherAETNA
1037295OtherHORIZON NJ HEALTH
334893OtherONE HEALTHPLAN
F09964OtherHEALTHNET
P634252OtherOXFORD
NJ3161102Medicaid
C47971OtherWELLCHOICE
NJ4122OtherEYEMED
0071821000OtherKEYSTONE
P634252OtherOXFORD
0071821000OtherKEYSTONE
1037295OtherHORIZON NJ HEALTH
1339341OtherUNITED HEALTHCARE