Provider Demographics
NPI:1316376593
Name:DAVID P TODD OD PC
Entity Type:Organization
Organization Name:DAVID P TODD OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-764-0100
Mailing Address - Street 1:565 W 2ND ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1510
Mailing Address - Country:US
Mailing Address - Phone:909-764-0100
Mailing Address - Fax:909-623-9575
Practice Address - Street 1:565 W 2ND ST
Practice Address - Street 2:UNIT 1
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1510
Practice Address - Country:US
Practice Address - Phone:909-764-0100
Practice Address - Fax:909-623-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty