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NPI Code Detail

MEDICARE: DR. DIANNE KOWING O.D.

MEDICARE: DR. DIANNE KOWING 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
1152W00000XOptometristOPC 2067FL
2152W00000XOptometristOP1000070DC

General Provider Information

NPI Number : 1356308852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANNE KOWING O.D.
Provider Business Mailing Address
First Line : 1517 N HALIFAX AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32118-3519
Country : US
Telephone Number : 386-248-3260
Fax Number :
Provider Business Practice Location Address
First Line : 551 NATIONAL HEALTH CARE DR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-1495
Country : US
Telephone Number : 386-323-7500
Fax Number : 386-323-7564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 07/08/2007

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