Provider Demographics
NPI:1720286438
Name:WILLIAM J. DIMINO, O.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM J. DIMINO, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-313-3191
Mailing Address - Street 1:503 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4231
Mailing Address - Country:US
Mailing Address - Phone:610-313-3191
Mailing Address - Fax:610-313-3193
Practice Address - Street 1:503 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-4231
Practice Address - Country:US
Practice Address - Phone:610-313-3191
Practice Address - Fax:610-313-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072263Medicare ID - Type Unspecified
PA5701530001Medicare NSC
PAU02255Medicare UPIN