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NPI Code Detail

MEDICARE: DIANA L HASKINS

MEDICARE: DIANA L HASKINS
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
1152W00000XOptometrist046008855IL

General Provider Information

NPI Number : 1326308941
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIANA L HASKINS
Provider Business Mailing Address
First Line : 635 CHICAGO AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-2365
Country : US
Telephone Number : 847-864-8209
Fax Number : 847-864-0058
Provider Business Practice Location Address
First Line : 635 CHICAGO AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-2365
Country : US
Telephone Number : 847-864-8209
Fax Number : 847-864-0058
Authorized Official
Title or Position : OWNER
Name : DIANA L HASKINS
Credential : O.D.
Telephone Number : 847-864-8209
Provider Enumeration Date : 05/17/2012
Last Update Date : 05/17/2012

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Directions to “DIANA L HASKINS ” Practice Location

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