MEDICARE: DR. IRENE DIEP 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	13166T	CA

General Provider Information

NPI Number	:	1194915272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE DIEP OD

Provider Business Mailing Address
First Line	:	1001 S BROADWAY STE F
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-4034
Country	:	US
Telephone Number	:	213-749-9966
Fax Number	:	213-277-5865

Provider Business Practice Location Address
First Line	:	1001 S BROADWAY STE F
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015
Country	:	US
Telephone Number	:	213-749-9966
Fax Number	:	213-277-5865

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	08/01/2018

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