Healthcare Provider Details

I. General information

NPI: 1760471668
Provider Name (Legal Business Name): DIANE LYNN KAPADIA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE TEEPLES

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HAMPTON POINT DR STE 3
ST AUGUSTINE FL
32092-3058
US

IV. Provider business mailing address

161 HAMPTON POINT DR STE 3
ST AUGUSTINE FL
32092-3058
US

V. Phone/Fax

Practice location:
  • Phone: 904-287-9137
  • Fax: 904-287-9057
Mailing address:
  • Phone: 904-287-9137
  • Fax: 904-287-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: