Provider Demographics
NPI:1568500916
Name:MARTHA DIAZ, O.D., P.C.
Entity Type:Organization
Organization Name:MARTHA DIAZ, O.D., P.C.
Other - Org Name:NORTHSIDE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ENRIQUETA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-742-5244
Mailing Address - Street 1:PO BOX 11998
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-1998
Mailing Address - Country:US
Mailing Address - Phone:281-467-5524
Mailing Address - Fax:
Practice Address - Street 1:3305 ORLANDO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-4854
Practice Address - Country:US
Practice Address - Phone:713-742-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150971301Medicaid
TX150971301Medicaid