Provider Demographics
NPI:1104007517
Name:DISKIN, MAURY I (OD)
Entity Type:Individual
Prefix:DR
First Name:MAURY
Middle Name:I
Last Name:DISKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:255 E BASSE RD STE 330
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8343
Practice Address - Country:US
Practice Address - Phone:210-308-8565
Practice Address - Fax:210-525-8317
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2021-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX6740T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist