Provider Demographics
NPI:1477740272
Name:OOSTING, DAVID WAYNE (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:OOSTING
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 1:9 W MAIN ST
Mailing Address - Street 2:# 10
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1135
Mailing Address - Country:US
Mailing Address - Phone:231-924-9870
Mailing Address - Fax:231-924-6307
Practice Address - Street 1:9 W MAIN ST
Practice Address - Street 2:# 10
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1135
Practice Address - Country:US
Practice Address - Phone:231-924-9870
Practice Address - Fax:231-924-6307
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F26504OtherBLUE CROSS BLUE SHIELD
MI0146700001OtherNATIONAL GOVERNMENT SERVI
MIP16990001Medicare PIN
MIT33320Medicare UPIN