Provider Demographics
NPI:1215038583
Name:RIDDLESPURGER, DAVID A (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:RIDDLESPURGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 HARRISBURG RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4349
Mailing Address - Country:US
Mailing Address - Phone:325-690-9537
Mailing Address - Fax:
Practice Address - Street 1:4150 SOUTHWEST DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8222
Practice Address - Country:US
Practice Address - Phone:325-692-8396
Practice Address - Fax:325-698-3305
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2065T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752335081OtherFEDERAL TAX ID
TXT15546Medicare UPIN
TXE74EMedicare ID - Type Unspecified