Provider Demographics
NPI:1679750632
Name:DIFIORE ENTERPRISES INC.
Entity Type:Organization
Organization Name:DIFIORE ENTERPRISES INC.
Other - Org Name:OPTIQUE BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIFIORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-234-7881
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152WC0802X152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141308Medicare PIN
NJ0697860001Medicare NSC