Provider Demographics
NPI:1053350546
Name:SANTASANIA, RICHARD JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:SANTASANIA
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346-0127
Mailing Address - Country:US
Mailing Address - Phone:570-839-5746
Mailing Address - Fax:570-839-5748
Practice Address - Street 1:HC 89
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346-9801
Practice Address - Country:US
Practice Address - Phone:570-839-5746
Practice Address - Fax:579-839-5748
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016250340003Medicaid
PASA169084Medicare ID - Type Unspecified
PAU63394Medicare UPIN