Provider Demographics
NPI:1578668125
Name:DIEHL, WILLIAM D (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:DIEHL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:502 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5523
Mailing Address - Country:US
Mailing Address - Phone:580-233-3599
Mailing Address - Fax:580-237-2570
Practice Address - Street 1:502 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5523
Practice Address - Country:US
Practice Address - Phone:580-233-3599
Practice Address - Fax:580-237-2570
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK802152W00000X, 152WC0802X, 152WL0500X, 152WX0102X, 152WP0200X, 152WS0006X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761850AMedicaid
OKT40419Medicare UPIN
OK100761850AMedicaid
OK0275860001Medicare NSC
OK244234514Medicare PIN