Provider Demographics
NPI:1396021663
Name:DIANE MARIE CATES, O.D., P.A.
Entity type:Organization
Organization Name:DIANE MARIE CATES, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-220-6421
Mailing Address - Street 1:12461 MARIAH ANN CT S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2674
Mailing Address - Country:US
Mailing Address - Phone:904-220-6421
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004670100Medicaid
FLHO029AMedicare PIN