Provider Demographics
NPI:1619044401
Name:D'ELIA, DANIEL MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:D'ELIA
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 1:319 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4930
Mailing Address - Country:US
Mailing Address - Phone:717-396-0680
Mailing Address - Fax:717-396-3833
Practice Address - Street 1:319 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4930
Practice Address - Country:US
Practice Address - Phone:717-396-0680
Practice Address - Fax:717-396-3833
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014960260006Medicaid
PA459403F8RMedicare PIN
PA0014960260006Medicaid