Provider Demographics
NPI:1447228671
Name:DIAMOND OPTICAL INC
Entity Type:Organization
Organization Name:DIAMOND OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VLIET
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT OPTICIAN
Authorized Official - Phone:330-688-1800
Mailing Address - Street 1:4299 KENT RD.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4365
Mailing Address - Country:US
Mailing Address - Phone:330-688-1800
Mailing Address - Fax:330-688-1824
Practice Address - Street 1:4299 KENT RD.
Practice Address - Street 2:SUITE #1
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4365
Practice Address - Country:US
Practice Address - Phone:330-688-1800
Practice Address - Fax:330-688-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0316570001Medicare NSC