MEDICARE: DIANA TAMBOLI M.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	207W00000X	Ophthalmology Physician	Q3979	TX
2	207W00000X	Ophthalmology Physician	125061038	IL
3	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	32188	OK

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	:	1346534146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA TAMBOLI M.D.

Provider Business Mailing Address
First Line	:	7316 N WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7120
Country	:	US
Telephone Number	:	405-708-7876
Fax Number	:

Provider Business Practice Location Address
First Line	:	9821 S MAY AVE # C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7042
Country	:	US
Telephone Number	:	405-708-7876
Fax Number	:

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	12/05/2024

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Directions to “ DIANA TAMBOLI M.D.” Practice Location

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