Provider Demographics
NPI:1073664421
Name:DIAMOND, ALAN H (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14219 MOUNT TER
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3828
Mailing Address - Country:US
Mailing Address - Phone:952-935-3910
Mailing Address - Fax:
Practice Address - Street 1:7204 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3210
Practice Address - Country:US
Practice Address - Phone:952-928-7005
Practice Address - Fax:952-928-4910
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP23334OtherHEALTHPARTNERS
0005510605OtherAETNA
637861016604OtherPREFERREDONE
26847DIOtherBCBSMN
22-01007OtherMEDICA
22-15201OtherMEDICA
0005510605OtherAETNA