Provider Demographics
NPI:1760572226
Name:PERSIANI, DENO MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DENO
Middle Name:MICHAEL
Last Name:PERSIANI
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 1:1480 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4646
Mailing Address - Country:US
Mailing Address - Phone:513-829-3935
Mailing Address - Fax:
Practice Address - Street 1:5211 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3533
Practice Address - Country:US
Practice Address - Phone:513-829-2111
Practice Address - Fax:513-829-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0711886Medicaid
OHT48509Medicare UPIN
OHPE0727624Medicare ID - Type Unspecified