Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Michael Pasquale Derenzo, LDO

Individual provider Optician · NPI 1114678646

Mr. Michael Pasquale Derenzo, LDO is an Optician in Blackwood, New Jersey. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2022

Practice location Address checks out

1 Harmon Dr
Blackwood, NJ 08012-5103
Phone: (856) 228-1000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optician (primary) Taxonomy 156FX1800X · Licence 006765 (NY)

Record details

NPI number1114678646
Entity typeIndividual (Type 1)
GenderMale
Credentials LDO
Sole proprietorYes
NPI enumeratedJanuary 17, 2022
Last updated in NPPESJanuary 17, 2022
Certification dateJanuary 17, 2022

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