Individual
DR. DIANE SHAHARA JAMOUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4555 WILSON AVE SW, GRANDVILLE, MI 49418-2370
(616) 249-8490
(616) 249-3129
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004760
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740620376
—
MI
Enumeration date
06/27/2013
Last updated
04/27/2021
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