Provider Demographics
NPI:1740098052
Name:WEBBER, DIANNE LESLIE
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:LESLIE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 SOUTHERN CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2070
Mailing Address - Country:US
Mailing Address - Phone:573-216-1590
Mailing Address - Fax:
Practice Address - Street 1:7577 CENTRAL PARKE BLVD STE 219
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6806
Practice Address - Country:US
Practice Address - Phone:573-216-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist