Healthcare Provider Details

I. General information

NPI: 1619099769
Provider Name (Legal Business Name): DAVID ROY TANOUYE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 TOPAZ LN
GARDENA CA
90247-2596
US

IV. Provider business mailing address

1009 TOPAZ LN
GARDENA CA
90247-2596
US

V. Phone/Fax

Practice location:
  • Phone: 310-529-7209
  • Fax:
Mailing address:
  • Phone: 310-529-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8335T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT8335T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: