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Individual

MRS. DIANE ELAINE SHORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
415 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5517
(812) 333-1911
(812) 404-1072
Mailing address
415 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5517
(812) 333-1911
(812) 333-1602

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002480
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200892700
IN
Enumeration date
07/05/2006
Last updated
10/21/2020
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