Individual
DR. GUY ANDREW DIETELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1455 TOWNE SQUARE BLVD NW, ROANOKE, VA 24012-1612
(540) 265-0595
(540) 265-0596
Mailing address
75 BITTERSWEET LN, HARDY, VA 24101-3333
(540) 427-0567
(540) 427-4367
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
061800456
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009230645
—
VA
01
—
224243
ANTHEM PROVIDER #
VA
01
—
487193
NVA PROVIDER #
VA
01
—
5709659
AETNA PROVIDER #
VA
Enumeration date
05/10/2006
Last updated
07/18/2008
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