Provider Demographics
NPI:1114956786
Name:OVERBERGER, DIANA KAY (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:KAY
Last Name:OVERBERGER
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 1:23811 CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2908
Mailing Address - Country:US
Mailing Address - Phone:440-617-0765
Mailing Address - Fax:
Practice Address - Street 1:21014 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4305
Practice Address - Country:US
Practice Address - Phone:440-331-4644
Practice Address - Fax:440-356-5045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU90578Medicare UPIN
OHOV4084906Medicare ID - Type Unspecified