Provider Demographics
NPI:1073614780
Name:DILZER, DONALD SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SCOTT
Last Name:DILZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2818
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20134-4818
Mailing Address - Country:US
Mailing Address - Phone:540-338-1833
Mailing Address - Fax:
Practice Address - Street 1:530 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3171
Practice Address - Country:US
Practice Address - Phone:540-338-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA223707OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA2051619OtherAETNA HMO
VA258609OtherMAMSI
VA5076642OtherAETNA NON HMO
VA410001041Medicare PIN
VA2051619OtherAETNA HMO
VA223707OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA410001041Medicare ID - Type Unspecified