Provider Demographics
NPI:1609879576
Name:DIMARCO, STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:DIMARCO
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 1:9 MOUNT BETHEL PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNT BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343-5212
Mailing Address - Country:US
Mailing Address - Phone:570-897-5911
Mailing Address - Fax:570-897-5908
Practice Address - Street 1:9 MOUNT BETHEL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNT BETHEL
Practice Address - State:PA
Practice Address - Zip Code:18343-5212
Practice Address - Country:US
Practice Address - Phone:570-897-5911
Practice Address - Fax:570-897-5908
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000111152W00000X
NJ27TO00002800152W00000X
NJ27OA00505400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02095801OtherCAPITAL BLUE CROSS
PA02886800OtherCAPITAL BLUE CROSS
PA751252OtherKEYSTONE
PAPA07149OtherVISION BENEFITS OF AMERIC
PA751252OtherHIGHMARK BLUE SHIELD
PA0727860001OtherHEALTH NOW
PA232753266OtherHORIZON
PA396396OtherNAT'L. VISION ADMIN.
PA289678OtherPRIVATE HEALTHCARE SYSTEM
PA465212OtherAETNA
PA232753266OtherVISION SERVICE PLAN
PA1253981001OtherCIGNA HEALTHCARE
PA751252VMGMedicare PIN
PA1253981001OtherCIGNA HEALTHCARE
PA289678OtherPRIVATE HEALTHCARE SYSTEM
PA751252Medicare ID - Type UnspecifiedMEDICARE
PA751252OtherKEYSTONE