Provider Demographics
NPI:1154416246
Name:CATES, DIANE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:CATES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12461 MARIAH ANN CT SOUTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-220-6421
Mailing Address - Fax:904-220-6421
Practice Address - Street 1:2036 FORBES ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3802
Practice Address - Country:US
Practice Address - Phone:904-330-0466
Practice Address - Fax:904-387-1026
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC2901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003139190AMedicaid
FL004670100Medicaid
FLAJ993VMedicare PIN