Individual
DIANE C DEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1217 PILE ST, CLOVIS, NM 88101-5944
(575) 763-5522
(575) 763-4722
Mailing address
PO BOX 700, CLOVIS, NM 88102-0700
(575) 763-5522
(575) 763-4722
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2364
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM00P427
BCBS
NM
05
—
P1167
—
NM
Enumeration date
01/20/2006
Last updated
06/15/2011
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