Provider Demographics
NPI:1295778124
Name:DUFFY, DAVID M (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DUFFY
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 1:1103 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3619
Mailing Address - Country:US
Mailing Address - Phone:484-889-8985
Mailing Address - Fax:
Practice Address - Street 1:1103 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3619
Practice Address - Country:US
Practice Address - Phone:484-889-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001415152W00000X
PAOEG000992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKZ41 /OtherBC / BS OF MD
MDS186 /OtherBLUECHOICE
MDKZ41 /OtherBC / BS OF MD