Provider Demographics
NPI:1326195199
Name:OEBKER, DAVID WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:OEBKER
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 1:5237 LINCOLN VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3949
Mailing Address - Country:US
Mailing Address - Phone:916-965-7464
Mailing Address - Fax:916-966-4720
Practice Address - Street 1:1855 41ST AVE
Practice Address - Street 2:STE G-11
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2511
Practice Address - Country:US
Practice Address - Phone:831-475-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7547T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0075470Medicare ID - Type Unspecified
CAU42910Medicare UPIN