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General NPI Number Information
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NPI Number | 1346534146
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Entity Type | Individual
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Provider Name | DIANA TAMBOLI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 9821 S MAY AVE # C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7042
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Country | US
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Telephone | 405-708-7876
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Fax |
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Provider Business Mailing Address
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Address Line | 7316 N WESTERN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-7120
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Country | US
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Telephone | 405-708-7876
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | Q3979
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 125061038
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 32188
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License Number State | OK
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