Provider Demographics
NPI:1922338433
Name:DIANA J DONCH OD PC
Entity type:Organization
Organization Name:DIANA J DONCH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DONCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-425-3937
Mailing Address - Street 1:146 W ADAMS ST
Mailing Address - Street 2:PO BOX 392
Mailing Address - City:COCHRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:16314-8640
Mailing Address - Country:US
Mailing Address - Phone:814-425-3937
Mailing Address - Fax:814-425-3378
Practice Address - Street 1:146 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-8640
Practice Address - Country:US
Practice Address - Phone:814-425-3937
Practice Address - Fax:814-425-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019511200001Medicaid
PAD0013654Medicare PIN
PAU25601Medicare UPIN