Provider Demographics
NPI:1801969019
Name:DIAZ, YOLANDA G (O D)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:G
Last Name:DIAZ
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1200 SE MILITARY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2804
Mailing Address - Country:US
Mailing Address - Phone:210-932-4922
Mailing Address - Fax:210-932-0047
Practice Address - Street 1:1200 SE MILITARY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2804
Practice Address - Country:US
Practice Address - Phone:210-932-4922
Practice Address - Fax:210-932-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2024-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5481TG152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0192643-01Medicaid