Provider Demographics
NPI:1184840795
Name:W D DIEHL OD INC
Entity Type:Organization
Organization Name:W D DIEHL OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-233-3599
Mailing Address - Street 1:502 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5523
Mailing Address - Country:US
Mailing Address - Phone:580-233-3599
Mailing Address - Fax:580-237-2570
Practice Address - Street 1:502 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5523
Practice Address - Country:US
Practice Address - Phone:580-233-3599
Practice Address - Fax:580-237-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761852AMedicaid
OK0275860001Medicare NSC
OK100761852AMedicaid
OK410047024Medicare PIN