Provider Demographics
NPI:1376643395
Name:ROSENBLUM, DAVID B (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:ROSENBLUM
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 1:11805 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6825
Mailing Address - Country:US
Mailing Address - Phone:562-860-4475
Mailing Address - Fax:562-924-3526
Practice Address - Street 1:326 LOS CERRITOS MALL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5425
Practice Address - Country:US
Practice Address - Phone:562-860-4475
Practice Address - Fax:562-924-3526
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10235T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10235TOtherSTATE LICENSE
CAMR0657645OtherDEA