Provider Demographics
NPI:1760539860
Name:JEW, DAVID H (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:JEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:576 N SUNRISE AVE
Mailing Address - Street 2:110
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2841
Mailing Address - Country:US
Mailing Address - Phone:916-773-3937
Mailing Address - Fax:
Practice Address - Street 1:2236 SOUTHSHORE CTR.
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-521-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10631T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU75534Medicare UPIN