Individual
DR. DANIEL D DIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1400 N BALDWIN AVE, MARION, IN 46952
(765) 664-6148
(765) 664-9782
Mailing address
PO BOX 168, MARION, IN 46952-0168
(765) 664-6148
(765) 664-9782
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002338A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000094740
—
IN
Enumeration date
03/22/2006
Last updated
08/15/2018
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