Provider Demographics
NPI:1225146889
Name:DIAZ, MARTHA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 TURNBERRY PARK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8275
Mailing Address - Country:US
Mailing Address - Phone:281-467-5524
Mailing Address - Fax:
Practice Address - Street 1:3305 ORLANDO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-4854
Practice Address - Country:US
Practice Address - Phone:713-742-5244
Practice Address - Fax:713-742-5739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5691TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150973901Medicaid
TX150973901Medicaid
U89639Medicare UPIN