Active NPI
Diane N Etter, OPTICIAN
- Optician
- Roanoke, VA
National Provider Identifier
1568545283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1101000741
- Practice address
- 2122 Colonial Ave SW
Roanoke, VA 24015-3205 - Phone
- (540) 342-1796
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 1101000741 | VA | Primary |
Addresses
Primary practice location
2122 Colonial Ave SW
Roanoke, VA 24015-3205
Mailing address
2122 Colonial Ave SW
Roanoke, VA 24015-3205
Phone (540) 342-1796
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1101000741 | VA | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Etter Enterprises Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Eyewear Supplier
- Roanoke, VA
- NPI 1285819151
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199836800000",
"number": "1568545283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2122 COLONIAL AVE SW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240153205",
"telephone_number": "540-342-1796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2122 COLONIAL AVE SW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240153205",
"telephone_number": "540-342-1796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTER",
"first_name": "DIANE",
"middle_name": "N",
"name_prefix": "Mrs.",
"credential": "OPTICIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2008-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "VA",
"license": "1101000741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.