Provider Demographics
NPI:1508856378
Name:NEWMAN, DAVID MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:NEWMAN
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 1:5642 LAKE MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1929
Mailing Address - Country:US
Mailing Address - Phone:619-589-6263
Mailing Address - Fax:619-501-2157
Practice Address - Street 1:5642 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1929
Practice Address - Country:US
Practice Address - Phone:619-589-6263
Practice Address - Fax:619-501-2157
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7296T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0072960Medicaid
CAT70185Medicare UPIN
OP7296Medicare PIN
CASD0072960Medicaid