Provider Demographics
NPI:1912007774
Name:PALOMBI, JOSEPH SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SCOTT
Last Name:PALOMBI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J. SCOTT
Other - Middle Name:
Other - Last Name:PALOMBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-656-0970
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR # 88MDG
Practice Address - Street 2:
Practice Address - City:WRIGHT PAT
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-656-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT1446152WC0802X
OH4671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU58500Medicare UPIN