Individual
DR. JASON RICHARD DIEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1025 COLUMBIA CTR, COLUMBIA, IL 62236-2546
(618) 281-8611
(618) 281-3927
Mailing address
40 E NORTH ST, EUREKA, MO 63025-1205
(636) 200-4393
(636) 938-2650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00397557
RAILROAD MEDICARE
IL
Enumeration date
03/18/2006
Last updated
10/02/2014
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