Provider Demographics
NPI:1093219313
Name:ORLANDO A DIAZ JR
Entity Type:Organization
Organization Name:ORLANDO A DIAZ JR
Other - Org Name:ORLANDO A DIAZ OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:405-473-3937
Mailing Address - Street 1:114 RENE PL
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-8980
Mailing Address - Country:US
Mailing Address - Phone:405-473-3937
Mailing Address - Fax:
Practice Address - Street 1:660 SW 19TH ST STE G
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5406
Practice Address - Country:US
Practice Address - Phone:405-794-0176
Practice Address - Fax:405-794-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761630AMedicaid