Provider Demographics
NPI:1508894007
Name:DINI, SUSAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:DINI
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 1:9040A JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-3760
Mailing Address - Fax:
Practice Address - Street 1:2939 BENJAMIN CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4807
Practice Address - Country:US
Practice Address - Phone:360-970-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021046Medicaid
WA5001612OtherAETNA
WA2046506OtherGROUP MEDICAID
WA3108383OtherAETNA HMO
WA912113458OtherPREMERA PNWEYECARE
WA1199DIOtherREGENCE BS
WA2033124Medicaid
WA2033124Medicaid
WAG8870353Medicare PIN