Provider Demographics
NPI:1720074396
Name:CULVER, DAVID R (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:CULVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:R
Other - Last Name:CULVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:222 S RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-0415
Mailing Address - Country:US
Mailing Address - Phone:309-833-4391
Mailing Address - Fax:309-833-1691
Practice Address - Street 1:222 S RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-0415
Practice Address - Country:US
Practice Address - Phone:309-833-4391
Practice Address - Fax:309-833-1691
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-0006825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL015252001OtherDMERC
IL410021980OtherRAILROAD MEDICARE
IL272221OtherHEALTHLINK
IL015252001OtherDMERC
645560Medicare ID - Type Unspecified