Individual
DIANE TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1035 HICKORY CREEK BLVD, HICKORY CREEK, TX 75065-7552
(940) 626-0088
Mailing address
5742 MALCOMBORO DR, HOUSTON, TX 77041-6582
(843) 450-0746
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7771T
TX
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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