Individual
DIANA MAURER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2209 MEMORIAL DR, WAYCROSS, GA 31501-0902
(912) 285-2021
(912) 285-2558
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001210
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000872781A
—
GA
01
—
08529
SPECTERA INS ID
—
01
—
101698
AVESIS RUN GA MEDICAID
GA
Enumeration date
01/24/2007
Last updated
11/17/2023
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