1396829073 NPI number — DAVID A. DORTCH,O.D. A CALIFORNIA PROFESSIONAL OPTEMETRIC CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396829073 NPI number — DAVID A. DORTCH,O.D. A CALIFORNIA PROFESSIONAL OPTEMETRIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A. DORTCH,O.D. A CALIFORNIA PROFESSIONAL OPTEMETRIC CORPORATION
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:
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:
1396829073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39252 WINCHESTER ROAD
Provider Second Line Business Mailing Address:
STE 127
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92563-3511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-600-9226
Provider Business Mailing Address Fax Number:
866-268-5876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39252 WINCHESTER ROAD
Provider Second Line Business Practice Location Address:
STE 127
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-600-9226
Provider Business Practice Location Address Fax Number:
866-268-5876
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DORTCH
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
951-600-9226

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT10758 , 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)





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