Provider Demographics
NPI:1730158908
Name:FALSETTA, DEENA T (OD)
Entity type:Individual
Prefix:DR
First Name:DEENA
Middle Name:T
Last Name:FALSETTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DEENA
Other - Middle Name:T
Other - Last Name:FALSETTA-GILBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1290
Mailing Address - Country:US
Mailing Address - Phone:434-385-5600
Mailing Address - Fax:
Practice Address - Street 1:1547 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6111
Practice Address - Country:US
Practice Address - Phone:757-425-0200
Practice Address - Fax:757-428-2823
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800452152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618001314OtherOPTOMETRIST TPA#
VA0618001314OtherOPTOMETRIST TPA#
VAU92557Medicare UPIN