Provider Demographics
NPI:1790777498
Name:STARESINIC, DANIELLE (OD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STARESINIC
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 1:4122 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3162
Mailing Address - Country:US
Mailing Address - Phone:412-682-2339
Mailing Address - Fax:412-382-2809
Practice Address - Street 1:4122 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-3162
Practice Address - Country:US
Practice Address - Phone:412-682-2339
Practice Address - Fax:412-682-2809
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019235370002Medicaid
OH058539OtherMEDICARE PTAN
OH058539OtherMEDICARE PTAN
PAU62954Medicare UPIN
PA4428370001Medicare NSC