Individual
DR. MARIA I DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
64 THOMPSON ST, SUITE B104, EAST HAVEN, CT 06513-5707
(203) 469-1012
(203) 467-1369
Mailing address
64 THOMPSON ST, SUITE B104, EAST HAVEN, CT 06513-5707
(203) 469-1012
(203) 467-1369
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2426
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004173598
—
CT
01
—
090002426CT12
ANTHEM BCBS
CT
01
—
544893
CONNECTICARE
CT
Enumeration date
02/28/2006
Last updated
10/02/2012
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