Individual
DR. DIANE SUSAN SANTESSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1040 NW 22ND AVE, STE. 168, PORTLAND, OR 97210-3057
(503) 413-7022
(503) 413-7066
Mailing address
1040 NW 22ND AVE, STE. 168, PORTLAND, OR 97210-3057
(503) 413-7022
(503) 413-7066
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3256T
OR
152W00000X
Optometrist
OD-472
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000213205
HMSA (380 HUKU LII, #107)
HI
01
—
0000213207
HMSA (KAISER ADDRESS)
HI
05
—
087295-01
—
HI
01
—
1145
UHA (380 HUKU LII, #107)
HI
Enumeration date
10/06/2006
Last updated
08/13/2008
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