Provider Demographics
NPI:1710318522
Name:DAVID LEFEVRE, OD, PLLC
Entity Type:Organization
Organization Name:DAVID LEFEVRE, OD, PLLC
Other - Org Name:DUPONT FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-912-0900
Mailing Address - Street 1:1570 WILMINGTON DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8773
Mailing Address - Country:US
Mailing Address - Phone:253-912-0900
Mailing Address - Fax:253-912-8080
Practice Address - Street 1:1570 WILMINGTON DR
Practice Address - Street 2:SUITE 160
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8773
Practice Address - Country:US
Practice Address - Phone:253-912-0900
Practice Address - Fax:253-912-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1555261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124183264OtherINDIVIDUAL NPI