MEDICARE: DR. ROBERT N 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	OA04226	NJ
2	152W00000X	Optometrist	TO000371	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2620503	OTHER		AETNA

General Provider Information

NPI Number	:	1568437671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT N DIAMOND OD

Provider Business Mailing Address
First Line	:	101 PROSPECT ST
Second Line	:	SUITE 102
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5003
Country	:	US
Telephone Number	:	732-367-0699
Fax Number	:	732-367-0937

Provider Business Practice Location Address
First Line	:	101 PROSPECT ST
Second Line	:	SUITE 102
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5003
Country	:	US
Telephone Number	:	732-367-0699
Fax Number	:	732-367-0937

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/16/2013

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