Individual
DR. GARY LEE DIETTERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
21 CORPORATE DR, STE.#2, EASTON, PA 18045-2664
(610) 258-2442
(610) 258-7965
Mailing address
21 CORPORATE DR, STE.#2, EASTON, PA 18045-2664
(610) 258-2442
(610) 258-7965
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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