MEDICARE: DR. SANDRA L KOZEL-DIAMOND OD

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	1241	NE
2	152W00000X	Optometrist	1409	SC

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	:	1316933989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA L KOZEL-DIAMOND OD

Provider Business Mailing Address
First Line	:	906 BUR OAK CT
Second Line	:	APT D
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-5273
Country	:	US
Telephone Number	:	843-333-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 HIGHWAY 9 E
Second Line	:	SUITE 260
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7833
Country	:	US
Telephone Number	:	843-390-0058
Fax Number	:	843-390-0999

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/02/2008

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