Healthcare Provider Details

I. General information

NPI: 1578668125
Provider Name (Legal Business Name): WILLIAM D DIEHL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W OWEN K GARRIOTT RD
ENID OK
73701-5523
US

IV. Provider business mailing address

502 W OWEN K GARRIOTT RD
ENID OK
73701-5523
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-3599
  • Fax: 580-237-2570
Mailing address:
  • Phone: 580-233-3599
  • Fax: 580-237-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number802
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number802
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number802
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number802
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number802
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number802
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number802
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: