Healthcare Provider Details

I. General information

NPI: 1356370712
Provider Name (Legal Business Name): DAVID CHRISTOPHER ARDAYA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 WASHINGTON BLVD
WHITTIER CA
90606-3111
US

IV. Provider business mailing address

11245 WASHINGTON BLVD
WHITTIER CA
90606-3111
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-1208
  • Fax: 562-695-6386
Mailing address:
  • Phone: 562-692-1208
  • Fax: 562-695-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: