Healthcare Provider Details

I. General information

NPI: 1174592562
Provider Name (Legal Business Name): DAVID A SILVER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-4011
US

IV. Provider business mailing address

2466 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-4011
US

V. Phone/Fax

Practice location:
  • Phone: 954-492-1177
  • Fax: 954-492-0352
Mailing address:
  • Phone: 954-492-1177
  • Fax: 954-492-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: