Healthcare Provider Details

I. General information

NPI: 1043105315
Provider Name (Legal Business Name): DAVID IERSTON-BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 F ST
CHULA VISTA CA
91910-2625
US

IV. Provider business mailing address

342 F ST
CHULA VISTA CA
91910-2625
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-1471
  • Fax:
Mailing address:
  • Phone: 619-422-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: