Provider Demographics
NPI:1174521371
Name:DROBNY, NICHOLAS (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DROBNY
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 1:301 EAST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1846
Mailing Address - Country:US
Mailing Address - Phone:570-387-8800
Mailing Address - Fax:570-784-8887
Practice Address - Street 1:301 EAST ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1846
Practice Address - Country:US
Practice Address - Phone:570-387-8800
Practice Address - Fax:570-784-8887
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADRO99960OtherBLUE SHIELD
PA01542401OtherCAPITAL BLUE CROSS
PA808800OtherFIRST PRIORITY HEALTH
PA099960OtherKEYSTONE HEALTH PLAN CENT
PA099960HHOMedicare ID - Type Unspecified
PAT28578Medicare UPIN