Basic Information
| Provider Information | |||||||||
| NPI: | 1013211598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEGA HERNANDEZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 W HORSESHOE AVE | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852335265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802769983 | ||||||||
| FaxNumber: | 4808927580 | ||||||||
| Practice Location | |||||||||
| Address1: | 7260 W BELL RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853088539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234861888 | ||||||||
| FaxNumber: | 6234868001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2010 | ||||||||
| LastUpdateDate: | 12/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1784 | AZ | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC4536 | FL | N | Eye and Vision Services Providers | Optometrist |
No ID Information.