Provider Demographics
NPI:1982600243
Name:DESIMONE, JEFFREY F (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:F
Last Name:DESIMONE
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 1:2 E MAITLAND LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1248
Mailing Address - Country:US
Mailing Address - Phone:724-658-4700
Mailing Address - Fax:
Practice Address - Street 1:2 E MAITLAND LN
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1248
Practice Address - Country:US
Practice Address - Phone:724-658-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410006252OtherMEDICARE RR
PA0014582400002Medicaid
PA0014582400002Medicaid