MEDICARE: MARTHA DIAZ, O.D., P.C.

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

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	:	1568500916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA DIAZ, O.D., P.C.

Provider Business Mailing Address
First Line	:	PO BOX 11998
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77293-1998
Country	:	US
Telephone Number	:	281-467-5524
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-742-5244
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTHA ENRIQUETA DIAZ
Credential	:	O.D.
Telephone Number	:	713-742-5244

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/02/2009

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