Provider Demographics
NPI:1669414454
Name:THOMAS L DALONZO PC
Entity type:Organization
Organization Name:THOMAS L DALONZO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DALONZO
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:610-626-9124
Mailing Address - Street 1:420 N SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1304
Mailing Address - Country:US
Mailing Address - Phone:610-626-9124
Mailing Address - Fax:610-626-0901
Practice Address - Street 1:420 N SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018-1304
Practice Address - Country:US
Practice Address - Phone:610-626-9124
Practice Address - Fax:610-626-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-08-09
Deactivation Date:2008-01-15
Deactivation Code:
Reactivation Date:2010-08-09
Provider Licenses
StateLicense IDTaxonomies
PAOEG000921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30262Medicare UPIN
PA413741Medicare ID - Type UnspecifiedMEDICARE