Provider Demographics
NPI:1457595589
Name:DIAZ, ALFREDO (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 TRINITY ST.
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852
Mailing Address - Country:US
Mailing Address - Phone:830-352-3118
Mailing Address - Fax:
Practice Address - Street 1:590 E. MAIN ST. STE D
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852
Practice Address - Country:US
Practice Address - Phone:830-325-6856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician