Individual
DR. MICHELLE DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
99 US ROUTE 1 BYP, KITTERY, ME 03904
(207) 439-0410
(207) 439-8353
Mailing address
99 US ROUTE 1 BYP STE A, KITTERY, ME 03904-1792
(072) 439-0410
(207) 439-8353
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0594
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30009844
—
NH
01
—
AA549786
HARVARD
ME
Enumeration date
05/23/2005
Last updated
06/04/2018
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