Provider Demographics
NPI:1366331605
Name:DEFLORIA, GINA DOLORIS (OD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:DOLORIS
Last Name:DEFLORIA
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:708 GRANGE DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5633
Mailing Address - Country:US
Mailing Address - Phone:724-454-6684
Mailing Address - Fax:
Practice Address - Street 1:936 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1527
Practice Address - Country:US
Practice Address - Phone:215-485-5384
Practice Address - Fax:215-485-5709
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist