Provider Demographics
NPI:1568437671
Name:DIAMOND, ROBERT N (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 PROSPECT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5003
Mailing Address - Country:US
Mailing Address - Phone:732-367-0699
Mailing Address - Fax:732-367-0937
Practice Address - Street 1:101 PROSPECT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5003
Practice Address - Country:US
Practice Address - Phone:732-367-0699
Practice Address - Fax:732-367-0937
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA04226152W00000X
NJTO000371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2620503OtherAETNA
U70623Medicare UPIN
2620503OtherAETNA