Provider Demographics
NPI:1821307182
Name:SHAVER, DIANE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:SHAVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7371 N APPLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9443
Mailing Address - Country:US
Mailing Address - Phone:541-862-2739
Mailing Address - Fax:541-862-2739
Practice Address - Street 1:1600 N RIVERSIDE AVE UNIT 2027
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4665
Practice Address - Country:US
Practice Address - Phone:541-779-9851
Practice Address - Fax:541-779-9851
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2817AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist