Provider Demographics
NPI:1003816950
Name:GILBERT, DIANA WATKINS (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:WATKINS
Last Name:GILBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 N PAVILLION
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4885
Mailing Address - Country:US
Mailing Address - Phone:513-860-0400
Mailing Address - Fax:
Practice Address - Street 1:8629 N PAVILLION
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4885
Practice Address - Country:US
Practice Address - Phone:513-860-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU71465Medicare UPIN
OHGI0853415Medicare PIN