Provider Demographics
NPI:1144395898
Name:PAUL, DAVID F (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:PAUL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3586
Mailing Address - Country:US
Mailing Address - Phone:586-573-4477
Mailing Address - Fax:586-573-0305
Practice Address - Street 1:12415 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3586
Practice Address - Country:US
Practice Address - Phone:586-573-4477
Practice Address - Fax:586-573-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06566Medicare PIN
MIT 78243Medicare UPIN
MI0314930001Medicare NSC