Provider Demographics
NPI:1265466940
Name:TRULL, DAVID W (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:TRULL
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 1:2240 WINROW RD
Mailing Address - Street 2:
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7079
Mailing Address - Country:US
Mailing Address - Phone:520-533-9193
Mailing Address - Fax:520-533-4766
Practice Address - Street 1:991 E MONTE VISTA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-0403
Practice Address - Country:US
Practice Address - Phone:209-634-8591
Practice Address - Fax:209-634-8596
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10866T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0108660Medicaid
CAZZZ15986ZMedicare PIN
U69956Medicare UPIN
CA0587900001Medicare NSC