Provider Demographics
NPI:1952469199
Name:ZELINKA, DIANE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:ZELINKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:JUPITER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 GRUBB RD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4799
Mailing Address - Country:US
Mailing Address - Phone:302-475-6500
Mailing Address - Fax:302-475-9528
Practice Address - Street 1:2500 GRUBB RD
Practice Address - Street 2:SUITE 234
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4799
Practice Address - Country:US
Practice Address - Phone:302-475-6500
Practice Address - Fax:302-475-9528
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003515B86Medicare PIN
U49297Medicare UPIN