MEDICARE: DR. MARTHA DIAZ O.D.

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	5691TG	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

General Provider Information

NPI Number	:	1225146889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA DIAZ O.D.

Provider Business Mailing Address
First Line	:	1119 TURNBERRY PARK LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8275
Country	:	US
Telephone Number	:	281-467-5524
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-742-5244
Fax Number	:	713-742-5739

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/26/2009

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