Provider Demographics
NPI:1427011345
Name:BABA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 COLLINS DR STE A
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3155
Mailing Address - Country:US
Mailing Address - Phone:209-383-1246
Mailing Address - Fax:209-383-0258
Practice Address - Street 1:3178 COLLINS DR STE A
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3155
Practice Address - Country:US
Practice Address - Phone:209-383-1246
Practice Address - Fax:209-383-0258
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7718T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077180Medicaid
CASD0077180Medicare PIN
CASD0077180Medicaid
CASD0077180Medicare ID - Type Unspecified