Individual
ANTHONY J DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
61 BEAVER DR, DU BOIS, PA 15801-2401
(814) 371-4020
(814) 371-1930
Mailing address
61 BEAVER DR, DU BOIS, PA 15801-2401
(814) 371-4020
(814) 371-1930
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000621
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0366780001
DMERC
PA
01
—
DE53721
PA BLUE SHIELD
PA
Enumeration date
06/09/2006
Last updated
12/04/2015
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