MEDICARE: DR. DIANE E GREGORY 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	05568T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174562250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE E GREGORY O.D.

Provider Business Mailing Address
First Line	:	3650 EAGLE CREEK DR
Second Line	:
City	:	MONT BELVIEU
State	:	TX
Zip	:	77523-5501
Country	:	US
Telephone Number	:	281-385-2020
Fax Number	:	281-385-2055

Provider Business Practice Location Address
First Line	:	3650 EAGLE CREEK DR
Second Line	:
City	:	MONT BELVIEU
State	:	TX
Zip	:	77523-5501
Country	:	US
Telephone Number	:	281-385-2020
Fax Number	:	281-385-2055

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	08/16/2012

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