MEDICARE: DR. DIANE MARIE MACDONALD 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	0618000610	VA

General Provider Information

NPI Number	:	1730210170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE MARIE MACDONALD O.D.

Provider Business Mailing Address
First Line	:	4238 WILSON BLVD
Second Line	:	SUITE 2266
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1823
Country	:	US
Telephone Number	:	703-527-7000
Fax Number	:	703-527-1000

Provider Business Practice Location Address
First Line	:	4238 WILSON BLVD
Second Line	:	SUITE 2266
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1823
Country	:	US
Telephone Number	:	703-527-7000
Fax Number	:	703-527-1000

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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