Provider Demographics
NPI:1477633006
Name:COLLETTE, DAVID P (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:COLLETTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:341 PALMETTO GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6396
Mailing Address - Country:US
Mailing Address - Phone:843-742-1006
Mailing Address - Fax:
Practice Address - Street 1:155 DORSET ST
Practice Address - Street 2:PEARLE VISION CENTER UNIVERSITY MALL
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6346
Practice Address - Country:US
Practice Address - Phone:802-658-4113
Practice Address - Fax:802-862-8945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist