Diane Marie Wallach, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618001150 Issued in VA

Practice address

209 Granby St
Norfolk, VA 23510-1805

Phone

(757) 627-3937

Fax

(757) 627-5689

NPI assigned

Oct 19, 2005

Last updated

Dec 27, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

New England College of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: diane.wallach.1@17183.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DRS. Lundberg and Lodwick, Optometrists PC

  dba Williamsburg Eye Care

  • Optometrist
  • Williamsburg, VA
  • NPI 1114070869
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1497744791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 GRANBY ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101805",
            "telephone_number": "757-627-3937",
            "fax_number": "757-627-5689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 GRANBY ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101805",
            "telephone_number": "757-627-3937",
            "fax_number": "757-627-5689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-19",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cydney T Wallace, DPT
• John Wallace Sr., IDC
• Logan Grace Gary Wallace, MD
• Robin E. Wallace, PHYSICIAN ASSISTANT
• Taylor Sterling Wallace, M.D.
• Daniel Waller
• Eva Jayne Waller, M.D.
• Jerri Ashley Waller, MD
• Timothy Bernard Walls, M.D.
• Bernardita Walsh, BS

• Optometrist in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.