Provider Demographics
NPI:1467430587
Name:OSBORNE, DOUGLAS MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MITCHELL
Last Name:OSBORNE
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 1:2910 JEFFERSON
Mailing Address - Street 2:STE 101
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2357
Mailing Address - Country:US
Mailing Address - Phone:760-729-4327
Mailing Address - Fax:760-729-4105
Practice Address - Street 1:2910 JEFFERSON
Practice Address - Street 2:STE 101
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2357
Practice Address - Country:US
Practice Address - Phone:760-729-4327
Practice Address - Fax:760-729-4105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6526T152W00000X
WA1251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0065260Medicaid
OP6526TMedicare ID - Type Unspecified
CASD0065260Medicaid