Provider Demographics
NPI:1699713826
Name:D'ALONZO, THOMAS L (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:D'ALONZO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1304
Mailing Address - Country:US
Mailing Address - Phone:610-626-9124
Mailing Address - Fax:610-626-0901
Practice Address - Street 1:420 N SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018-1304
Practice Address - Country:US
Practice Address - Phone:610-626-9124
Practice Address - Fax:610-626-0901
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA413741Medicare PIN
PAT30262Medicare UPIN
PA5732940001Medicare NSC
PA410005634Medicare PIN