Healthcare Provider Details

I. General information

NPI: 1912198151
Provider Name (Legal Business Name): ADIS DIAZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 SUN VISTA DR
LUTZ FL
33559-6861
US

IV. Provider business mailing address

PO BOX 207151
DALLAS TX
75320-7151
US

V. Phone/Fax

Practice location:
  • Phone: 813-607-2730
  • Fax: 656-223-2000
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007172
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: