Provider Demographics
NPI:1871641530
Name:DOMNITCH, DAVID REID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REID
Last Name:DOMNITCH
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 1:5413 MOUNT GREENWICH CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2148
Mailing Address - Country:US
Mailing Address - Phone:703-978-8320
Mailing Address - Fax:
Practice Address - Street 1:614 17TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-4802
Practice Address - Country:US
Practice Address - Phone:202-298-6878
Practice Address - Fax:202-347-7180
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP 459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist