Organization
JON F DIETLEIN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON F DIETLEIN M.D. (PRESIDENT)
(512) 931-2255
Entity
Organization
Contact information
Practice address
311 RIVER BEND DR, GEORGETOWN, TX 78628-2782
(512) 931-2255
(512) 819-9528
Mailing address
311 RIVER BEND DR, GEORGETOWN, TX 78628-2782
(512) 931-2255
(512) 819-9528
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
04076T
TX
207W00000X
Ophthalmology Physician
Primary
H0298
TX
Other
Enumeration date
12/18/2006
Last updated
04/17/2009
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