# JON F DIETLEIN, M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DIETLEIN OPTICAL BOUTIQUE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295860930
- **Authorized official:** MR. JON F DIETLEIN M.D. (PRESIDENT)
- **Authorized official phone:** (512) 931-2255

## Contact information

- **Practice address:** 311 RIVER BEND DR, GEORGETOWN, TX 78628-2782
- **Practice address phone:** (512) 931-2255
- **Practice address fax:** (512) 819-9528
- **Mailing address:** 311 RIVER BEND DR, GEORGETOWN, TX 78628-2782
- **Mailing address phone:** (512) 931-2255
- **Mailing address fax:** (512) 819-9528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 06/12/2008