Provider Demographics
NPI:1942384755
Name:DONDIEGO, ROBERT DANIEL (OD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:DONDIEGO
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 1:2 MILLER PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3608
Mailing Address - Country:US
Mailing Address - Phone:631-360-3420
Mailing Address - Fax:
Practice Address - Street 1:2 MILLER PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3608
Practice Address - Country:US
Practice Address - Phone:631-360-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC14242Medicare ID - Type Unspecified
NYU62948Medicare UPIN