Provider Demographics
NPI:1356461321
Name:BABAYAN, DIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:BABAYAN
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 1:437 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1438
Mailing Address - Country:US
Mailing Address - Phone:707-747-1016
Mailing Address - Fax:
Practice Address - Street 1:480 REDWOOD ST STE 11
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2958
Practice Address - Country:US
Practice Address - Phone:707-643-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12275T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0012275Medicaid
CASD0012275Medicaid
CASD0122750Medicare ID - Type Unspecified