Provider Demographics
NPI:1811065444
Name:LIGHT, DAVID ALAN (CPO, LPO)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:LIGHT
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 HOWARD ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3179
Mailing Address - Country:US
Mailing Address - Phone:325-227-8183
Mailing Address - Fax:325-944-0994
Practice Address - Street 1:20 HOWARD ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3179
Practice Address - Country:US
Practice Address - Phone:325-227-8183
Practice Address - Fax:325-949-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist