Provider Demographics
NPI:1730210170
Name:MACDONALD, DIANE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4238 WILSON BLVD
Mailing Address - Street 2:SUITE 2266
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1823
Mailing Address - Country:US
Mailing Address - Phone:703-527-7000
Mailing Address - Fax:703-527-1000
Practice Address - Street 1:4238 WILSON BLVD
Practice Address - Street 2:SUITE 2266
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1823
Practice Address - Country:US
Practice Address - Phone:703-527-7000
Practice Address - Fax:703-527-1000
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist