| Organization Name: | BEN DOMIANO OPTICAL INCORPORATED |
| NPI Number: | 1639125214 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BENJAMIN G DOMIANO (PRESIDENT) |
| Mailing Address: | 817 S Main St Old Forge |
| State: | PA US |
| Postal Code: | 185181431 |
| Phone Number: | 5704572020 |
| Fax Number: | 5704572787 |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 02/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |