Provider Demographics
NPI:1598197675
Name:DIAZ, OSVALDO (OD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 PORTSMOUTH BLVD STE 237
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:757-539-6591
Practice Address - Street 1:2444 CHESAPEAKE SQUARE RING RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2173
Practice Address - Country:US
Practice Address - Phone:757-968-9889
Practice Address - Fax:757-539-8505
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4795152W00000X
SC1764152W00000X
VA0618002240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist