NPIMap

Organization Active NPI

Ben Domiano Optical Center LLC

  • Optician
  • Old Forge, PA
National Provider Identifier
1992090096
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
30685 Issued in PA
Legal business name
BEN DOMIANO OPTICAL CENTER LLC
Practice address
817 S Main St
Old Forge, PA 18518-1431
Phone
(570) 457-2020
Fax
(570) 457-2787
NPI assigned
Jun 16, 2011
Last updated
Jun 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ben Domiano, ABOC
Title
President
Phone
(570) 457-2020

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OEG000082 PA
Contact Lens Technician/TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 156FC0800X 30685 PA
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X 30685 PA Primary

Addresses

Primary practice location

817 S Main St
Old Forge, PA 18518-1431

Mailing address

817 S Main St
Old Forge, PA 18518-1431
Phone (570) 457-2020

National Provider Directory

National Provider Directory

Locations

817 S Main St
Old Forge, PA 18518
Phone (570) 457-2020

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1992090096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 S MAIN ST",
            "city": "OLD FORGE",
            "state": "PA",
            "postal_code": "185181431",
            "telephone_number": "570-457-2020",
            "fax_number": "570-457-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 S MAIN ST",
            "city": "OLD FORGE",
            "state": "PA",
            "postal_code": "185181431",
            "telephone_number": "570-457-2020",
            "fax_number": "570-457-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEN DOMIANO OPTICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "DOMIANO",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-457-2020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ABOC"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000082",
            "primary": false
        },
        {
            "code": "156FC0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Contact Lens",
            "state": "PA",
            "license": "30685",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "PA",
            "license": "30685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Old Forge, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.