Provider Demographics
NPI:1427038959
Name:MCDIARMID, JOHN J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:MCDIARMID
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 1:3953 W STETSON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-9687
Mailing Address - Country:US
Mailing Address - Phone:951-652-4343
Mailing Address - Fax:951-765-6039
Practice Address - Street 1:25395 HANCOCK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9054
Practice Address - Country:US
Practice Address - Phone:951-696-5388
Practice Address - Fax:951-696-5391
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9467T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094670Medicaid
CAU55050Medicare UPIN
CASD0094670Medicare ID - Type Unspecified