Provider Demographics
NPI:1871762161
Name:DBP OPTICAL
Entity type:Organization
Organization Name:DBP OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:PIANTONI
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:609-890-2110
Mailing Address - Street 1:2660 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4110
Mailing Address - Country:US
Mailing Address - Phone:609-890-2110
Mailing Address - Fax:609-890-0987
Practice Address - Street 1:2660 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-4110
Practice Address - Country:US
Practice Address - Phone:609-890-2110
Practice Address - Fax:609-890-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ156FX1800X156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0776310001Medicare NSC