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1568897890 NPI number — MELISSA ANN DIAMOND O.D.

NPI Number: 1568897890
Health Care Provider/Practitioner: MELISSA ANN DIAMOND O.D.

Information about “1568897890” NPI (MELISSA ANN DIAMOND O.D.) exists in 1568897890 in HTML format HTML  |  1568897890 in plain Text format TXT  |  1568897890 in PDF (Portable Document Format) PDF  |  1568897890 in an XML format XML  formats.

NPI Number : 1568897890 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568897890",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIAMOND",
    "FirstName": "MELISSA",
    "MiddleName": "ANN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VANZIN",
    "OtherFirstName": "MELISSA",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "O.D",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "146 MAPLE HL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAYNESBURG",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15370-8219",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "724-986-4258",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9520 MALL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORGANTOWN",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "26501-8524",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-983-6557",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/05/2013",
    "LastUpdateDate": "02/10/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "2005-IOD",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "OEG002787",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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