Provider Demographics
NPI:1700914785
Name:HESS, DIANA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:HESS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 NE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5642
Mailing Address - Country:US
Mailing Address - Phone:503-257-0448
Mailing Address - Fax:
Practice Address - Street 1:1890 NE 162ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5642
Practice Address - Country:US
Practice Address - Phone:503-257-0448
Practice Address - Fax:503-256-1131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2401T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133829Medicare ID - Type Unspecified
ORU78917Medicare UPIN