Provider Demographics
NPI:1629762067
Name:ANTHONY S. DIECIDUE, P.C.
Entity Type:Organization
Organization Name:ANTHONY S. DIECIDUE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GLASNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-476-1114
Mailing Address - Street 1:1421 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2008
Mailing Address - Country:US
Mailing Address - Phone:570-382-3922
Mailing Address - Fax:
Practice Address - Street 1:1421 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2008
Practice Address - Country:US
Practice Address - Phone:570-382-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty