Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14444 | CA |
NPI | 1003171661 |
---|---|
Provider Name | David Jason Border |
First Address | Modesto, CA 95356-8774 |
Second Address | Ceres, CA 95307-9420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 02/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GN227A | (02) | CA |