Provider Demographics
NPI:1528103173
Name:KERRIS, DIANE E (OD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:KERRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3242 COVE BEND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2752
Mailing Address - Country:US
Mailing Address - Phone:813-265-6940
Mailing Address - Fax:813-908-3937
Practice Address - Street 1:3242 COVE BEND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2752
Practice Address - Country:US
Practice Address - Phone:813-265-6940
Practice Address - Fax:813-908-3937
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20807OtherBCBS
FLU67994Medicare UPIN