1437110749 NPI number — DR. DAVID F CAMARA O.D.

Table of content: DR. DAVID F CAMARA O.D. (NPI 1437110749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437110749 NPI number — DR. DAVID F CAMARA O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMARA
Provider First Name:
DAVID
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437110749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGOURA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91376-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-707-8567
Provider Business Mailing Address Fax Number:
818-707-8567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 W FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROVIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91016-1938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-707-8567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT10484T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1306035118 . This is a "NPI - ADVANCED EYECARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0104840 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DP2509 . This is a "RAILROAD MEDICARE PIN - ADVANCED EYECARE, INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 410044901 . This is a "PALMETTO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 6191070001 . This is a "DMEPOS - ADVANCED EYECARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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