Healthcare Provider Details

I. General information

NPI: 1427083039
Provider Name (Legal Business Name): DAVID W. OTTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 COYLE AVENUE STE 270
CARMICHAEL CA
95608
US

IV. Provider business mailing address

6660 COYLE AVENUE STE 270
CARMICHAEL CA
95608
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-0497
  • Fax: 916-961-5736
Mailing address:
  • Phone: 916-961-0497
  • Fax: 916-961-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA30377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: