Individual
DR. NATHAN CURTIS DIECKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1115 N HENDERSON ST, GALESBURG, IL 61401-2523
(309) 343-1107
(309) 343-1306
Mailing address
1115 N HENDERSON ST, GALESBURG, IL 61401-2523
(309) 343-1107
(309) 343-1306
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010231
IL
152W00000X
Optometrist
2010018379
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014545
MEDICARE PTAN
MO
05
—
1841423753
—
MO
Enumeration date
08/25/2009
Last updated
07/05/2015
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