Provider Demographics
NPI:1447208780
Name:FORREST, DAVID SHEPARD (OD PA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHEPARD
Last Name:FORREST
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 OAKBROOK CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3440
Mailing Address - Country:US
Mailing Address - Phone:305-332-5332
Mailing Address - Fax:
Practice Address - Street 1:2616 OAKBROOK CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-3440
Practice Address - Country:US
Practice Address - Phone:305-332-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20614Medicare ID - Type UnspecifiedOPTOMETRIST