Individual
DR. MICHELE L DOMIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
189 N MAIN ST, OLD FORGE, PA 18518
(570) 451-2020
(570) 451-3083
Mailing address
189 N MAIN ST, OLD FORGE, PA 18518
(570) 451-2020
(570) 451-3083
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
MD0417368
PA
152W00000X
Optometrist
Primary
OEG000869
PA
152W00000X
Optometrist
OEO07704T
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101849890
—
PA
01
—
1379469
BLUE CROSS/BLUE SHIELD
PA
01
—
814343
FIRST PRIORITY HEALTH
PA
Enumeration date
02/14/2006
Last updated
11/20/2008
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