Provider Demographics
NPI:1194415190
Name:DIETZ, ALEECE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:ALEECE
Middle Name:MARIE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ALEECE
Other - Middle Name:MARIE
Other - Last Name:KANAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1210 JTL PKWY E STE 103
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-7037
Mailing Address - Country:US
Mailing Address - Phone:479-777-2697
Mailing Address - Fax:479-763-3212
Practice Address - Street 1:1210 JTL PKWY E STE 103
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-7037
Practice Address - Country:US
Practice Address - Phone:479-777-2697
Practice Address - Fax:479-763-3212
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3228152W00000X
AR2887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist