Provider Demographics
NPI:1568499382
Name:DENNIS, DAVID LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:DENNIS
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 1:3416 BECHELLI LANE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2432
Mailing Address - Country:US
Mailing Address - Phone:530-222-1422
Mailing Address - Fax:530-222-5282
Practice Address - Street 1:3416 BECHELLI LANE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2432
Practice Address - Country:US
Practice Address - Phone:530-222-1422
Practice Address - Fax:530-222-5282
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061990Medicaid
CA6199TOtherOPTOMETRIC LICENSE
T10260Medicare UPIN
CA0536040001Medicare NSC
CASD0061990Medicaid