Provider Demographics
NPI:1871507590
Name:DARBENZIO, NICHOLAS F (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:F
Last Name:DARBENZIO
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 1:406 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-2020
Mailing Address - Country:US
Mailing Address - Phone:570-602-9607
Mailing Address - Fax:
Practice Address - Street 1:345 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:PA
Practice Address - Zip Code:18641-1448
Practice Address - Country:US
Practice Address - Phone:570-602-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000120152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA029590ND2Medicare ID - Type Unspecified