Provider Demographics
NPI:1629521919
Name:DAVID S FORREST OD,PA
Entity Type:Organization
Organization Name:DAVID S FORREST OD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:OD,PA
Authorized Official - Phone:305-332-5332
Mailing Address - Street 1:2616 OAKBROOK CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3440
Mailing Address - Country:US
Mailing Address - Phone:305-332-5332
Mailing Address - Fax:
Practice Address - Street 1:2616 OAKBROOK CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-3440
Practice Address - Country:US
Practice Address - Phone:305-332-5332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty