Provider Demographics
NPI:1821080151
Name:DINOVO, ANDREA MICHELLE (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:DINOVO
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 1:1832 CASTLETON WAY
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1301
Mailing Address - Country:US
Mailing Address - Phone:740-363-2015
Mailing Address - Fax:740-369-2408
Practice Address - Street 1:1832 CASTLETON WAY
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1301
Practice Address - Country:US
Practice Address - Phone:740-363-2015
Practice Address - Fax:740-369-2408
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2522274Medicaid
OH4146401Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OHV02309Medicare UPIN