Provider Demographics
NPI:1629026570
Name:JURAS, DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:JURAS
Suffix:
Gender:F
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-0023
Mailing Address - Country:US
Mailing Address - Phone:843-693-2505
Mailing Address - Fax:843-216-0066
Practice Address - Street 1:605 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2758
Practice Address - Country:US
Practice Address - Phone:843-863-1215
Practice Address - Fax:843-553-7335
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0956152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00435798OtherRR MEDICARE
SCD09569Medicaid
SCU23554Medicare UPIN
SCD09569Medicaid