Provider Demographics
NPI:1053191411
Name:LUA, DIANA P (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:LUA
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 S 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5354
Mailing Address - Country:US
Mailing Address - Phone:928-287-9138
Mailing Address - Fax:
Practice Address - Street 1:2501 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7734
Practice Address - Country:US
Practice Address - Phone:928-317-6874
Practice Address - Fax:928-317-6876
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2386I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician