Basic Information
| Provider Information | |||||||||
| NPI: | 1366866063 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIANA P. CAMARGO O.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 NE 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333345987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544915628 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2900 W CYPRESS CREEK RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333091715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549792191 | ||||||||
| FaxNumber: | 9549798988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2014 | ||||||||
| LastUpdateDate: | 02/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | CAMARGO | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
| AuthorizedOfficialMiddleName: | PATRICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9544915628 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC 4304 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.