Provider Demographics
NPI:1568530780
Name:LITTLEJOHN, DAVID LEE (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:LITTLEJOHN
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 1:8090 LOONEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9250
Mailing Address - Country:US
Mailing Address - Phone:937-606-2772
Mailing Address - Fax:937-916-3206
Practice Address - Street 1:8090 LOONEY RD STE B
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9250
Practice Address - Country:US
Practice Address - Phone:937-606-2772
Practice Address - Fax:937-916-3206
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4367 T273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311542500OtherTAX ID