Provider Demographics
NPI:1912104811
Name:DIMARCO, DAVID JOSEPH JR (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:DIMARCO
Suffix:JR
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 1:7000 STONEWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7376
Mailing Address - Country:US
Mailing Address - Phone:1724-940-4001
Mailing Address - Fax:
Practice Address - Street 1:7000 STONEWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-940-4001
Practice Address - Fax:724-940-4001
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000345152W00000X
PAOEG001912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013945Medicaid
VT3001328OtherMVP HEALTHCARE
VT9005130OtherFAHC
VTP00419885OtherRAILROAD MEDICARE
VT00070231OtherBLUE CROSS/BLUESHIELD VT
VT1013945Medicaid
VT3001328OtherMVP HEALTHCARE