Individual
DIANNE ELIZABETH PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
8190 WINDFALL LN, STE C, CAMBY, IN 46113-7906
(317) 856-2000
Mailing address
1426 E COMMANDER CT., BLOOMINGTON, IN 47401
(812) 320-4362
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002637B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200893590
—
IN
01
—
8562000
VISION SERVICE PLAN
—
01
—
OP2618
EYEMED VSION CARE
—
Enumeration date
02/22/2007
Last updated
12/16/2010
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