Provider Demographics
NPI:1174557094
Name:DOMBROWSKI, DENNIS E (OD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:E
Last Name:DOMBROWSKI
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 1:816 ESTELLE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2135
Mailing Address - Country:US
Mailing Address - Phone:717-898-8878
Mailing Address - Fax:717-898-4679
Practice Address - Street 1:816 ESTELLE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2135
Practice Address - Country:US
Practice Address - Phone:717-898-8878
Practice Address - Fax:717-898-4679
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000467152W00000X, 152WP0200X, 152WS0006X
PA0EG000467152WC0802X
PAOEGOOO467152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1174557094Medicare NSC
591082JHTMedicare PIN
PAU08998Medicare UPIN