Individual
MRS. DIANE N ETTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
2122 COLONIAL AVE SW, ROANOKE, VA 24015-3205
(540) 342-1796
Mailing address
2122 COLONIAL AVE SW, ROANOKE, VA 24015-3205
(540) 342-1796
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101000741
VA
Other
Enumeration date
10/24/2006
Last updated
01/09/2008
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