MEDICARE: DR. JENNIFER DIAMOND O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	008350	NY
2	152WP0200X	Pediatric Optometrist	008350	NY

General Provider Information

NPI Number	:	1043694763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER DIAMOND O.D

Provider Business Mailing Address
First Line	:	2011 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3801
Country	:	US
Telephone Number	:	718-469-3311
Fax Number	:	718-434-0539

Provider Business Practice Location Address
First Line	:	2011 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3801
Country	:	US
Telephone Number	:	718-469-3311
Fax Number	:	718-434-0539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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