Provider Demographics
NPI:1629238928
Name:VIOLETTE, DIANE LEE (LDO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE
Last Name:VIOLETTE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041A US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3742
Mailing Address - Country:US
Mailing Address - Phone:727-868-0780
Mailing Address - Fax:727-868-0819
Practice Address - Street 1:10041A US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3742
Practice Address - Country:US
Practice Address - Phone:727-868-0780
Practice Address - Fax:727-868-0819
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3953156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630276900Medicaid