Provider Demographics
NPI:1275164238
Name:DIAZ, MADELYN (OD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
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 1:7000 SW 97TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1492
Mailing Address - Country:US
Mailing Address - Phone:786-452-8787
Mailing Address - Fax:786-452-8786
Practice Address - Street 1:7000 SW 97TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1492
Practice Address - Country:US
Practice Address - Phone:786-452-8787
Practice Address - Fax:786-452-8786
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist