Provider Demographics
NPI:1891977393
Name:OBRIEN, DAVID V (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:OBRIEN
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 1:426 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-2413
Mailing Address - Country:US
Mailing Address - Phone:662-647-8707
Mailing Address - Fax:662-647-8706
Practice Address - Street 1:426 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2413
Practice Address - Country:US
Practice Address - Phone:662-647-8707
Practice Address - Fax:662-647-8706
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087700Medicaid
MS00087700Medicaid