Provider Demographics
NPI:1831257559
Name:DENNIS J DENICK OD, PC
Entity type:Organization
Organization Name:DENNIS J DENICK OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-497-1001
Mailing Address - Street 1:459 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1301
Mailing Address - Country:US
Mailing Address - Phone:215-497-1001
Mailing Address - Fax:
Practice Address - Street 1:459 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1301
Practice Address - Country:US
Practice Address - Phone:215-497-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2374619000OtherPERSONAL CHOICE
PA2374619000OtherKEYSTONE
PADE1702385OtherPA BLUE SHIELD
PADE1702385OtherPA BLUE SHIELD
PA2374619000OtherPERSONAL CHOICE
U58568Medicare UPIN
DD8666Medicare ID - Type UnspecifiedMEDICARE RAIL ROAD