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General NPI Number Information
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NPI Number | 1780683698
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Entity Type | Individual
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Provider Name | JASON L. DIAMOND O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 3700 SAWTELL RD SUITE B
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7873
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Country | US
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Telephone | 843-390-0058
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Fax | 843-390-9990
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Provider Business Mailing Address
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Address Line | 3700 SAWTELL RD B
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7873
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Country | US
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Telephone | 843-390-0058
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Fax | 843-390-0999
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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 | 1244
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License Number State | NE
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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 | 1408
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2086
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License Number State | NC
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