Provider Demographics
NPI:1245594407
Name:BUCK, DAVID MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:BUCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1215 GEORGE WASHINGTON MEM HWY STE V
Mailing Address - Street 2:SUITE V
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4316
Mailing Address - Country:US
Mailing Address - Phone:757-596-5666
Mailing Address - Fax:757-596-9755
Practice Address - Street 1:1215 GEORGE WASHINGTON MEM HWY STE V
Practice Address - Street 2:SUITE V
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4316
Practice Address - Country:US
Practice Address - Phone:757-596-5666
Practice Address - Fax:757-596-9755
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618002155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist