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General NPI Number Information
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NPI Number | 1093219313
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Entity Type | Organization
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Legal Business Name | ORLANDO A DIAZ JR
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 660 SW 19TH ST STE G
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City | MOORE
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State | OK
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Zip | 73160-5406
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Country | US
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Telephone | 405-794-0176
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Fax | 405-794-0176
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Provider Business Mailing Address
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Address Line | 114 RENE PL
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City | SHAWNEE
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State | OK
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Zip | 74804-8980
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Country | US
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Telephone | 405-473-3937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ORLANDO A DIAZ JR.
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Credential | OD
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Telephone | 405-473-3937
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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 | 1153
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License Number State | OK
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