Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT7682T | CA |
NPI | 1114082112 |
---|---|
Provider Name | David J Suder |
First Address | San Diego, CA 92121-4234 |
Second Address | San Diego, CA 92121-4234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |