Provider Demographics
NPI:1013941491
Name:DIEHL, JOSHUA KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:KEITH
Last Name:DIEHL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 E MAIN ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-6224
Mailing Address - Country:US
Mailing Address - Phone:814-226-4862
Mailing Address - Fax:814-226-8741
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-6224
Practice Address - Country:US
Practice Address - Phone:814-226-4862
Practice Address - Fax:814-226-8741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6007380001Medicare PIN
PA110992WKBMedicare PIN