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General NPI Number Information
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NPI Number | 1053191411
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Entity Type | Individual
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Provider Name | DIANA P LUA LICENSED OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 2501 S AVENUE B
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City | YUMA
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State | AZ
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Zip | 85364-7734
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Country | US
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Telephone | 928-317-6874
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Fax | 928-317-6876
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Provider Business Mailing Address
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Address Line | 1874 S 17TH AVE
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City | YUMA
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State | AZ
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Zip | 85364-5354
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Country | US
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Telephone | 928-287-9138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 2386I
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License Number State | AZ
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