Provider Demographics
NPI:1952400939
Name:BLOOMBERG, DAVID ISAAC (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ISAAC
Last Name:BLOOMBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13035 POMERADO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4247
Mailing Address - Country:US
Mailing Address - Phone:858-486-7609
Mailing Address - Fax:858-486-7659
Practice Address - Street 1:13035 POMERADO RD
Practice Address - Street 2:SUITE C
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4247
Practice Address - Country:US
Practice Address - Phone:858-486-7609
Practice Address - Fax:858-486-7659
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12268T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95918Medicare UPIN
CAWOP12268FMedicare ID - Type Unspecified