Provider Demographics
NPI:1619420486
Name:DAVID S ALTENDERFER OD LLC
Entity Type:Organization
Organization Name:DAVID S ALTENDERFER OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ALTENDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-258-4372
Mailing Address - Street 1:518 WALLER WAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3543
Mailing Address - Country:US
Mailing Address - Phone:484-566-9242
Mailing Address - Fax:
Practice Address - Street 1:147 PALMER PARK MALL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2759
Practice Address - Country:US
Practice Address - Phone:610-258-4372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty