Provider Demographics
NPI:1154479335
Name:DISKIN, IRA PHILLIP (OD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:PHILLIP
Last Name:DISKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E BASSE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-8343
Mailing Address - Country:US
Mailing Address - Phone:210-308-8565
Mailing Address - Fax:210-525-8317
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?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2221T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist