MEDICARE: DR. JASON L. DIAMOND 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	1244	NE
2	152W00000X	Optometrist	1408	SC
3	152W00000X	Optometrist	2086	NC

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	:	1780683698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON L. DIAMOND O.D.

Provider Business Mailing Address
First Line	:	3700 SAWTELL RD B
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7873
Country	:	US
Telephone Number	:	843-390-0058
Fax Number	:	843-390-0999

Provider Business Practice Location Address
First Line	:	3700 SAWTELL RD
Second Line	:	SUITE B
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7873
Country	:	US
Telephone Number	:	843-390-0058
Fax Number	:	843-390-9990

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/01/2018

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