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General NPI Number Information
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NPI Number | 1235816067
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Entity Type | Individual
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Provider Name | DIBA OSSAREH OD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 5431 E SR 44 STE 1
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City | WILDWOOD
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State | FL
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Zip | 34785-8294
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Country | US
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Telephone | 352-632-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 919788
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City | ORLANDO
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State | FL
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Zip | 32891-9788
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Country | US
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Telephone | 888-856-1878
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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 | OPT35830
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC6388
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License Number State | FL
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