Provider Demographics
NPI:1891796207
Name:GIFFEN, DIANE L (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:GIFFEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-6354
Mailing Address - Country:US
Mailing Address - Phone:216-548-8278
Mailing Address - Fax:330-299-9656
Practice Address - Street 1:250 TALLMADGE RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7204
Practice Address - Country:US
Practice Address - Phone:330-299-9650
Practice Address - Fax:330-299-9656
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2842357Medicaid
OHU69219Medicare UPIN