Provider Demographics
NPI:1730951401
Name:RACER, DIANE WENDY
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:WENDY
Last Name:RACER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3535
Mailing Address - Country:US
Mailing Address - Phone:732-458-1794
Mailing Address - Fax:732-785-8351
Practice Address - Street 1:1872 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3535
Practice Address - Country:US
Practice Address - Phone:732-458-1794
Practice Address - Fax:732-785-8351
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician