Provider Demographics
NPI:1841260254
Name:ELDRIDGE, DAVID H (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR
Mailing Address - Street 2:#307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4808
Mailing Address - Country:US
Mailing Address - Phone:310-552-2030
Mailing Address - Fax:310-552-3021
Practice Address - Street 1:300 S BEVERLY DR
Practice Address - Street 2:#307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4808
Practice Address - Country:US
Practice Address - Phone:310-552-2030
Practice Address - Fax:310-552-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP4816Medicare ID - Type Unspecified