Provider Demographics
NPI:1760471668
Name:KAPADIA, DIANE LYNN (OD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:KAPADIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:TEEPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 HAMPTON POINT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3058
Mailing Address - Country:US
Mailing Address - Phone:904-287-9137
Mailing Address - Fax:904-287-9057
Practice Address - Street 1:161 HAMPTON POINT DR STE 3
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3058
Practice Address - Country:US
Practice Address - Phone:904-287-9137
Practice Address - Fax:904-287-9057
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620801100Medicaid
289899OtherAVMED
7099023OtherAETNA
19950OtherBLUE CROSS BLUE SHIELD
54573OtherCOORDINATED VISION
OPC3594OtherVISION SERVICE PLAN
OPC3594OtherOPTICARE EYE HEALTH
OPC3594OtherVISION CARE PLAN
FL620801100Medicaid
7099023OtherAETNA