Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10391T | CA |
NPI | 1003886615 |
---|---|
Provider Name | Dr. David Joseph Nota |
First Address | San Clemente, CA 92672-4011 |
Second Address | San Clemente, CA 92672-4011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 18/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
EC628Z | (02) | CA |
SD0103910 | (05) | CA |