Provider Demographics
NPI:1508214115
Name:DIEKEMA, CLAIRE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARIE
Last Name:DIEKEMA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:MARIE
Other - Last Name:STEENSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14530 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6425
Mailing Address - Country:US
Mailing Address - Phone:616-994-2844
Mailing Address - Fax:
Practice Address - Street 1:9239 W CENTER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1933
Practice Address - Country:US
Practice Address - Phone:888-840-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508214115Medicaid
MI0C97655Medicare PIN
MI07335000Medicare PIN