Provider Demographics
NPI:1144206079
Name:YU-DAVIS, DIANE LI-CHUAN (OD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LI-CHUAN
Last Name:YU-DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LICHUAN
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6406 N I H 35
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4352
Mailing Address - Country:US
Mailing Address - Phone:512-454-4401
Mailing Address - Fax:
Practice Address - Street 1:6406 N I H 35
Practice Address - Street 2:SUITE 1250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4352
Practice Address - Country:US
Practice Address - Phone:512-454-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12381T152W00000X
TX7703T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96163Medicare UPIN