Provider Demographics
NPI:1093905606
Name:DIRR, ADRIANNE S (OD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:S
Last Name:DIRR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044
Mailing Address - Country:US
Mailing Address - Phone:513-425-0817
Mailing Address - Fax:513-425-7101
Practice Address - Street 1:4102 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044
Practice Address - Country:US
Practice Address - Phone:513-425-0817
Practice Address - Fax:513-425-7101
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11770032OtherCAQH
OH1325810007Medicare NSC
OHSC4219998Medicare PIN
OHSC4219994Medicare PIN
OHSC4219992Medicare PIN
11770032OtherCAQH
OHSC4219993Medicare PIN
KY0740717Medicare PIN