Provider Demographics
NPI:1952454712
Name:MELTZER, DAVID LEONARD (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEONARD
Last Name:MELTZER
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 1:2003 BLUESAGE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1785
Mailing Address - Country:US
Mailing Address - Phone:707-568-6001
Mailing Address - Fax:
Practice Address - Street 1:1350 TRAVIS BLVD
Practice Address - Street 2:SOLANO MALL
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4646
Practice Address - Country:US
Practice Address - Phone:707-423-9380
Practice Address - Fax:707-423-9393
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10452Medicare UPIN