Provider Demographics
NPI:1831369669
Name:JOHN P. BOSCIA, OD
Entity type:Organization
Organization Name:JOHN P. BOSCIA, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-258-6666
Mailing Address - Street 1:2020 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8354
Mailing Address - Country:US
Mailing Address - Phone:610-258-6666
Mailing Address - Fax:
Practice Address - Street 1:2020 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8354
Practice Address - Country:US
Practice Address - Phone:610-258-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
PAOEG000704332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0177480002Medicare NSC