Healthcare Provider Details

I. General information

NPI: 1629249800
Provider Name (Legal Business Name): DAVID TAYLOR REARWIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MARKET PLACE DR
MONTEREY PARK CA
91755-7402
US

IV. Provider business mailing address

2000 MARKET PLACE DR
MONTEREY PARK CA
91755-7402
US

V. Phone/Fax

Practice location:
  • Phone: 323-726-7667
  • Fax:
Mailing address:
  • Phone: 323-726-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10727T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: