Provider Demographics
NPI:1629192620
Name:DIFIORE, PAUL D (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:DIFIORE
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 1:3223 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9746
Mailing Address - Country:US
Mailing Address - Phone:856-234-7881
Mailing Address - Fax:856-234-1395
Practice Address - Street 1:3223 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9746
Practice Address - Country:US
Practice Address - Phone:856-234-7881
Practice Address - Fax:856-234-1395
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00432500152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141308Medicare UPIN
NJU18279Medicare UPIN