Provider Demographics
NPI:1700147808
Name:STEWART, DAVID T
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ABO
Mailing Address - Street 1:PO BOX 25848
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0114
Mailing Address - Country:US
Mailing Address - Phone:480-718-9907
Mailing Address - Fax:888-371-0059
Practice Address - Street 1:817 W HARBOR DRVIE
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:619-238-1399
Practice Address - Fax:888-371-0059
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL6622156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician