Provider Demographics
NPI:1760863047
Name:DIAZ, COURTNEY IRENE (OD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:IRENE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:IRENE
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:926 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2920
Mailing Address - Country:US
Mailing Address - Phone:740-366-7341
Mailing Address - Fax:
Practice Address - Street 1:926 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2920
Practice Address - Country:US
Practice Address - Phone:740-366-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist