Provider Demographics
NPI:1194088252
Name:HERSCOVICI, DIEM CHI (OD)
Entity type:Individual
Prefix:DR
First Name:DIEM
Middle Name:CHI
Last Name:HERSCOVICI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIEMCHI
Other - Middle Name:HOANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:301 S 320TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5200
Mailing Address - Country:US
Mailing Address - Phone:253-874-7000
Mailing Address - Fax:866-559-3952
Practice Address - Street 1:22002 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7644
Practice Address - Country:US
Practice Address - Phone:830-224-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61371005152W00000X
NYTUV007843-1152W00000X
TX8987TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8987TGOtherTEXAS LICENSE
NYTUV007843-1OtherLICENSE