Provider Demographics
NPI:1003020223
Name:TODD, DAVID P JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:TODD
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:157 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2557
Mailing Address - Country:US
Mailing Address - Phone:608-873-8686
Mailing Address - Fax:760-873-5507
Practice Address - Street 1:157 PIONEER LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2557
Practice Address - Country:US
Practice Address - Phone:760-873-8686
Practice Address - Fax:760-873-5507
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3189152W00000X
VA0618001915152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69699Medicare UPIN
FL20796Medicare ID - Type Unspecified