MEDICARE: DR. PAOLA ROSARIO DIAZ OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8211T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1174660260	OTHER	TX	GROUP NPI

General Provider Information

NPI Number	:	1053753509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAOLA ROSARIO DIAZ OD

Provider Business Mailing Address
First Line	:	5044 TENNYSON PKWY
Second Line	:	STE B
City	:	PLANO
State	:	TX
Zip	:	75024-2953
Country	:	US
Telephone Number	:	972-378-4104
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 LUCAS DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-1804
Country	:	US
Telephone Number	:	214-528-7948
Fax Number	:	214-528-7387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	12/30/2019

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