Healthcare Provider Details

I. General information

NPI: 1891796207
Provider Name (Legal Business Name): DIANE L GIFFEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/07/2021
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 TALLMADGE RD
KENT OH
44240-7204
US

IV. Provider business mailing address

PO BOX 1154
HUDSON OH
44236-6354
US

V. Phone/Fax

Practice location:
  • Phone: 330-299-9650
  • Fax: 330-299-9656
Mailing address:
  • Phone: 216-548-8278
  • Fax: 330-299-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: