Individual
DENNIS R MIRRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O. D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
I3-0001149
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000302622
—
DE
01
—
1603
COVENTRY
DE
01
—
4405500
AETNA
DE
01
—
510292224
UNITED HEALTHCARE
DE
01
—
B86041
DE BLUE CROSS
DE
01
—
P01245272
PALMETTO GBA RR MEDICARE PTAN GROUP 1245251313
DE
Enumeration date
09/13/2005
Last updated
01/31/2014
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