Provider Demographics
NPI:1598197675
Name:DIAZ, OSVALDO (OD)
Entity type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 PLEASURE HOUSE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4046
Mailing Address - Country:US
Mailing Address - Phone:757-460-9402
Mailing Address - Fax:
Practice Address - Street 1:1608 PLEASURE HOUSE RD STE 106
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4046
Practice Address - Country:US
Practice Address - Phone:757-460-9402
Practice Address - Fax:757-460-9462
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4795152W00000X
SC1764152W00000X
VA0618002240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist