Provider Demographics
NPI:1659376978
Name:COSTA, DINO J (OD)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:J
Last Name:COSTA
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 1:1000 REGENCY CT
Mailing Address - Street 2:STE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3074
Mailing Address - Country:US
Mailing Address - Phone:419-882-0588
Mailing Address - Fax:419-885-3070
Practice Address - Street 1:1000 REGENCY CT
Practice Address - Street 2:STE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3074
Practice Address - Country:US
Practice Address - Phone:419-882-0588
Practice Address - Fax:419-885-3070
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000191838OtherANTHEM
03214OtherPARAMOUNT
OH0827912Medicaid
0004281126OtherAETNA
OH410045043OtherRAILROAD MEDICARE
1572615OtherUNITED HEALTHCARE
0004281126OtherAETNA
OH0827912Medicaid