Individual
DR. GARY LEE DIETTERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000606
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01776201
CAPITAL BC
PA
01
—
180026868
RR MEDICARE
PA
01
—
3803518
AETNA#
PA
01
—
624066
BLUE SHIELD
PA
01
—
P00227588
PALMETTO GBA RR MEDICARE
PA
Enumeration date
01/20/2006
Last updated
09/23/2008
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