Provider Demographics
NPI:1740410729
Name:CAMPOREALE, DAVID MARC (LDO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARC
Last Name:CAMPOREALE
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8177 GLADES RD
Mailing Address - Street 2:BAY-03
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4071
Mailing Address - Country:US
Mailing Address - Phone:561-479-4765
Mailing Address - Fax:561-479-4628
Practice Address - Street 1:8177 GLADES RD
Practice Address - Street 2:BAY-03
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4071
Practice Address - Country:US
Practice Address - Phone:561-479-4765
Practice Address - Fax:561-479-4628
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5930156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician