Provider Demographics
NPI:1841397973
Name:SHIBATA, DAVID PAUL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:SHIBATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42201 N 41ST DR
Mailing Address - Street 2:SUITE 144
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-9122
Mailing Address - Fax:623-551-9120
Practice Address - Street 1:42201 N 41ST DR
Practice Address - Street 2:SUITE 144
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-551-9122
Practice Address - Fax:623-551-9120
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117440Medicare ID - Type Unspecified
U87514Medicare UPIN