Provider Demographics
NPI:1659707883
Name:DRISCOLL, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 SANDHILL CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4800
Mailing Address - Country:US
Mailing Address - Phone:682-444-1195
Mailing Address - Fax:
Practice Address - Street 1:710 CENTERPARK DR STE 120
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2850
Practice Address - Country:US
Practice Address - Phone:866-349-9905
Practice Address - Fax:817-809-6910
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3527TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist