MEDICARE: DR. DIANE DIEP DO 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	5799T	TX

General Provider Information

NPI Number	:	1629065859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE DIEP DO O.D.

Provider Business Mailing Address
First Line	:	202 WILLARD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-2142
Country	:	US
Telephone Number	:	713-521-4595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 S GRAND PKWY
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-8257
Country	:	US
Telephone Number	:	281-693-3937
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/25/2011

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