Provider Demographics
NPI:1548212129
Name:HUGHES DEAN, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HUGHES DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 GRINDSTONE PKWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3755
Mailing Address - Country:US
Mailing Address - Phone:573-442-5725
Mailing Address - Fax:573-442-5747
Practice Address - Street 1:1205 GRINDSTONE PKWY
Practice Address - Street 2:SUITE 113
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-442-5725
Practice Address - Fax:573-442-5747
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006010743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006010743OtherMO
18003368OtherUPIN PENDING