Provider Demographics
NPI:1639227176
Name:DRACOPOULOS, DIANA E (OD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:E
Last Name:DRACOPOULOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:E
Other - Last Name:PHILLIPS MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5879
Mailing Address - Country:US
Mailing Address - Phone:414-253-1812
Mailing Address - Fax:
Practice Address - Street 1:315 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5879
Practice Address - Country:US
Practice Address - Phone:414-253-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009479152W00000X
SC2469152W00000X
WI4054-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU92371Medicare UPIN
ILU92371Medicare UPIN