1518186162 NPI number — DAVID R PLOTNER M.D. APC

Table of content: (NPI 1518186162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518186162 NPI number — DAVID R PLOTNER M.D. APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID R PLOTNER M.D. APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA EYE SPECIALISTS OF ESCONDIDO
Provider Other Organization Name Type Code:
3
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:
1518186162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W VALLEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92025-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-489-5100
Provider Business Mailing Address Fax Number:
760-489-6567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W VALLEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-489-5100
Provider Business Practice Location Address Fax Number:
760-489-6567
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIRK
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-489-5100

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G25905 , 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: 180005403 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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