MEDICARE: CLAIRE MARIE DIEKEMA 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	4901004958	MI

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	:	1508214115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE MARIE DIEKEMA O.D.

Provider Business Mailing Address
First Line	:	15086 MUSTANG DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-8855
Country	:	US
Telephone Number	:	616-994-2844
Fax Number	:

Provider Business Practice Location Address
First Line	:	3164 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9317
Country	:	US
Telephone Number	:	616-538-0150
Fax Number	:	616-669-8457

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

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	06/11/2026

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