Provider Demographics
NPI:1861450793
Name:PESTEANU, DIANA L (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:PESTEANU
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 1:12 ANNA LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-8648
Mailing Address - Country:US
Mailing Address - Phone:252-519-9401
Mailing Address - Fax:252-519-9404
Practice Address - Street 1:12 ANNA LOUISE LN
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-8648
Practice Address - Country:US
Practice Address - Phone:252-519-9401
Practice Address - Fax:252-519-9404
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890243LMedicaid
NC890928EMedicaid
NC2468675CMedicare PIN
NCU45377Medicare UPIN