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General NPI Number Information
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NPI Number | 1073664421
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Entity Type | Individual
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Provider Name | ALAN H. DIAMOND O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7204 MINNETONKA BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-3210
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Country | US
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Telephone | 952-928-7005
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Fax | 952-928-4910
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Provider Business Mailing Address
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Address Line | 14219 MOUNT TER
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City | MINNETONKA
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State | MN
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Zip | 55345-3828
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Country | US
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Telephone | 952-935-3910
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1864
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License Number State | MN
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