Active NPI
Diana Bennett, MD
- Ophthalmology Physician
- Portland, OR
National Provider Identifier
1770676355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD15309
- Practice address
- 3600 N Interstate Ave
Portland, OR 97227-1106 - Phone
- (503) 285-9321
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD15309 | OR | Primary |
| Ophthalmology Physician | 207W00000X | MD00034600 | WA |
Addresses
Primary practice location
3600 N Interstate Ave
Portland, OR 97227-1106
Mailing address
3600 N Interstate Ave
Portland, OR 97227-1106
Other names 1
- Diana Habrich
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD15309 | OR | MD | Ophthalmology Physician |
| MD00034600 | WA | MD | Ophthalmology Physician |
| 15309 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1770676355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 N INTERSTATE AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 N INTERSTATE AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271106",
"telephone_number": "503-285-9321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "DIANA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "OR",
"license": "MD15309",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WA",
"license": "MD00034600",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DIANA",
"last_name": "HABRICH",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.