Provider Demographics
NPI:1437104502
Name:BROSNAN, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BROSNAN
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 1:94B SERRAMONTE CTR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2345
Mailing Address - Country:US
Mailing Address - Phone:650-992-8007
Mailing Address - Fax:650-992-6560
Practice Address - Street 1:94B SERRAMONTE CTR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2345
Practice Address - Country:US
Practice Address - Phone:650-992-8007
Practice Address - Fax:650-992-6560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11410T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14006OtherMES
CA14006OtherMES
CAMB1089576OtherDEA