Provider Demographics
NPI:1518650472
Name:SANTOS-SARINANA, DAVID (LDO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANTOS-SARINANA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDO
Mailing Address - Street 1:2101 YOUNTS RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8505
Mailing Address - Country:US
Mailing Address - Phone:704-882-8341
Mailing Address - Fax:704-882-8518
Practice Address - Street 1:2101 YOUNTS RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8505
Practice Address - Country:US
Practice Address - Phone:704-882-8341
Practice Address - Fax:704-882-8518
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1691156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician