Provider Demographics
NPI:1508018607
Name:DAVID BLOCH OD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID BLOCH OD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-500-3300
Mailing Address - Street 1:2814 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1619
Mailing Address - Country:US
Mailing Address - Phone:760-500-3300
Mailing Address - Fax:
Practice Address - Street 1:2814 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1619
Practice Address - Country:US
Practice Address - Phone:760-730-3733
Practice Address - Fax:760-730-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9207T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW551Medicare PIN