MEDICARE: DR. OSVALDO DIAZ 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	OPC 4795	FL
2	152W00000X	Optometrist	1764	SC
3	152W00000X	Optometrist	0618002240	VA

General Provider Information

NPI Number	:	1598197675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSVALDO DIAZ O.D

Provider Business Mailing Address
First Line	:	1608 PLEASURE HOUSE RD STE 106
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4046
Country	:	US
Telephone Number	:	757-460-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 PLEASURE HOUSE RD STE 106
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4046
Country	:	US
Telephone Number	:	757-460-9402
Fax Number	:	757-460-9462

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	04/30/2024

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