Provider Demographics
NPI:1780778431
Name:PRINCE, DEBORAH L (OD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:PRINCE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3251 HOLIDAY COURT #689
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:619-224-2973
Mailing Address - Fax:619-224-0106
Practice Address - Street 1:3251 HOLIDAY COURT #689
Practice Address - Street 2:SUITE 200
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:760-489-1725
Practice Address - Fax:619-224-0106
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CACA12242TPA152W00000X
CA12242TPA152W00000X
FLOPC3733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist