Individual
MARTIN V DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4812 VALLEY VIEW BLVD NW, ROANOKE, VA 24012-2018
(540) 366-2208
Mailing address
901 BYRNE ST SW, ROANOKE, VA 24015-5547
(319) 321-0776
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002307
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0618002307
STATE OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
10/03/2013
Last updated
11/23/2014
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