Provider Demographics
NPI:1114082112
Name:SUDER, DAVID J (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SUDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10145 PACIFIC HEIGHTS BLVD
Mailing Address - Street 2:STE 700
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4234
Mailing Address - Country:US
Mailing Address - Phone:858-554-0799
Mailing Address - Fax:858-554-1306
Practice Address - Street 1:10145 PACIFIC HEIGHTS BLVD
Practice Address - Street 2:STE 700
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4234
Practice Address - Country:US
Practice Address - Phone:858-554-0799
Practice Address - Fax:858-554-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7682T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management