Provider Demographics
NPI:1124023312
Name:LIND, DIANA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIE
Last Name:LIND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1312
Mailing Address - Country:US
Mailing Address - Phone:308-236-5800
Mailing Address - Fax:308-236-8508
Practice Address - Street 1:4107 7TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1312
Practice Address - Country:US
Practice Address - Phone:308-236-5800
Practice Address - Fax:308-236-8508
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2013-08-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
NENE 213207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025136900Medicaid
NE10025136900Medicaid
278222Medicare ID - Type Unspecified