Provider Demographics
NPI:1255432985
Name:KAHLEY, DIANA JO
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:JO
Last Name:KAHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:JO
Other - Last Name:DONCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:146 W ADAMS ST
Mailing Address - City:COCHRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:16314
Mailing Address - Country:US
Mailing Address - Phone:814-425-3937
Mailing Address - Fax:814-425-3378
Practice Address - Street 1:146 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314
Practice Address - Country:US
Practice Address - Phone:814-425-3937
Practice Address - Fax:814-425-3378
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000457152W00000X
OH4607T1350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2426299Medicaid
PA990320Medicaid
PA990320Medicaid
OH2426299Medicaid
PA4816800001Medicare NSC
U52601Medicare UPIN