MEDICARE: DIANE DENISE STOVALL

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	156FX1800X	Optician	DO5521	FL

General Provider Information

NPI Number	:	1952256026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE DENISE STOVALL

Provider Business Mailing Address
First Line	:	10809 MASTERS DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-7114
Country	:	US
Telephone Number	:	407-785-5179
Fax Number	:

Provider Business Practice Location Address
First Line	:	10809 MASTERS DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-7114
Country	:	US
Telephone Number	:	407-785-5179
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ DIANE DENISE STOVALL ” Practice Location

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