Provider Demographics
NPI:1306405089
Name:GANDELMAN, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GANDELMAN
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 1:363 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6114
Mailing Address - Country:US
Mailing Address - Phone:207-530-8332
Mailing Address - Fax:
Practice Address - Street 1:363 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6114
Practice Address - Country:US
Practice Address - Phone:207-530-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT1005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist