Provider Demographics
NPI:1528166782
Name:DENNING, DIANE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:DENNING
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 1:201 E KRAFT AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1054
Mailing Address - Country:US
Mailing Address - Phone:215-498-2790
Mailing Address - Fax:
Practice Address - Street 1:1040 NIXON DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1171
Practice Address - Country:US
Practice Address - Phone:856-778-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00064700152W00000X
NJ27OA00587200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7485603OtherAETNA PIN
NJ7485603OtherAETNA PIN
NJ099750Medicare PIN