Provider Demographics
NPI:1013123603
Name:SCHWELLENBACH, DONALD DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DAVID
Last Name:SCHWELLENBACH
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 1:901 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3323
Mailing Address - Country:US
Mailing Address - Phone:530-674-8170
Mailing Address - Fax:530-674-5728
Practice Address - Street 1:901 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3323
Practice Address - Country:US
Practice Address - Phone:530-674-8170
Practice Address - Fax:530-674-5728
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT00007872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist