Michele L Domiano, OD
Individual provider Active NPI Optometrist · Old Forge, PA
NPI 1265406730 · NPPES record last updated Nov 20, 2008
Key facts
- NPI
- 1265406730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OEG000869 (PA)
- Practice address
- 189 N Main St
Old Forge, PA 18518 - Phone
- (570) 451-2020
- Fax
- (570) 451-3083
- NPI assigned
- Feb 14, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pennsylvania College of Optometry, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
189 N Main St
Old Forge, PA 18518-1755
Phone (570) 451-2020
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081114000539 | PA | Practitioner - Optometry | 2961579982 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OEG000869 | PA | MD | Optometrist |
| OEO07704T | PA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michele L Domiano OD PC | Optometrist | Current |
Accepting new patients |
Locations
189 N Main St
Old Forge, PA 18518
Phone (570) 451-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OEG000869 | PA | Yes |
| Optometrist | 152W00000X | MD0417368 | PA | |
| Optometrist | 152W00000X | OEO07704T | PA |
Addresses
Primary practice location
189 N Main St
Old Forge, PA 18518
Mailing address
189 N Main St
Old Forge, PA 18518
Phone (570) 451-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101849890 | Medicaid | PA | |
| 814343 | Other | PA | FIRST PRIORITY HEALTH |
| 1379469 | Other | PA | BLUE CROSS/BLUE SHIELD |
Other providers in Old Forge, PA
- Fiore Cremard III
- Kendra M Croker
- Kellyann Daley
- Jason Michael Depietropaolo
- Edward Dolinish
- Amanda Dranchak
- Darlene Ann Dunay
- Deborah M. Dunbar
- Deborah Ferri
- Jeffrey Frail
All providers in Old Forge, PA · Optometrist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.