Organization
GARY LEE DIETTERICK
Active
Other names
Palmer Family Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY L DIETTERICK OD (DR/OWNER)
(610) 258-2442
Entity
Organization
Contact information
Practice address
21 CORPORATE DR, EASTON, PA 18045-2664
(610) 258-2442
(610) 258-7961
Mailing address
21 CORPORATE DR, EASTON, PA 18045-2664
(610) 258-2442
(610) 258-7961
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000606
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02669200
CAPITAL BLUE CROSS
PA
01
—
3803518
AETNA
PA
01
—
624066
HIGHMARK BLUE SHIELD
PA
01
—
DD4313
PALMETTO GBA RAILROAD MED
PA
Enumeration date
07/16/2006
Last updated
10/10/2014
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