Organization
BEN DOMIANO OPTICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BEN DOMIANO ABOC (PRESIDENT)
(570) 457-2020
Entity
Organization
Contact information
Practice address
817 S MAIN ST, OLD FORGE, PA 18518-1431
(570) 457-2020
(570) 457-2787
Mailing address
817 S MAIN ST, OLD FORGE, PA 18518-1431
(570) 457-2020
(570) 457-2787
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG000082
PA
156FC0800X
Contact Lens Technician/Technologist
30685
PA
156FX1800X
Optician
Primary
30685
PA
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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