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General NPI Number Information
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NPI Number | 1073648671
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Entity Type | Individual
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Provider Name | DAVID JOSEPH SULLIVAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 276 S HOLLYWOOD BLVD
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2422
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Country | US
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Telephone | 740-264-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 276 S HOLLYWOOD BLVD
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2422
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Country | US
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Telephone | 740-264-1220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OH 4521 T 1218
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License Number State | OH
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