Provider Demographics
NPI:1760576987
Name:OLIVE, DAVID CLYDE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLYDE
Last Name:OLIVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2415 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8480
Practice Address - Country:US
Practice Address - Phone:334-521-7944
Practice Address - Fax:334-521-7277
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALS-931-TA-494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79413Medicare UPIN