Provider Demographics
NPI:1760482244
Name:HORN, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HORN
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 1:120 ALCOTT PL FRNT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4201
Mailing Address - Country:US
Mailing Address - Phone:718-379-8029
Mailing Address - Fax:718-862-0393
Practice Address - Street 1:120 ALCOTT PL
Practice Address - Street 2:FRONT 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4201
Practice Address - Country:US
Practice Address - Phone:718-379-8029
Practice Address - Fax:718-862-0393
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC27101Medicare PIN
NYT48938Medicare UPIN