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General NPI Number Information
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NPI Number | 1396829073
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Entity Type | Organization
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Legal Business Name | DAVID A. DORTCH,O.D. A CALIFORNIA PROFESSIONAL OPTEMETRIC CORPORATION
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 39252 WINCHESTER ROAD STE 127
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City | MURRIETA
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State | CA
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Zip | 92563-3511
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Country | US
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Telephone | 951-600-9226
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Fax | 866-268-5876
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Provider Business Mailing Address
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Address Line | 39252 WINCHESTER ROAD STE 127
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City | MURRIETA
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State | CA
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Zip | 92563-3511
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Country | US
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Telephone | 951-600-9226
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Fax | 866-268-5876
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DAVID A DORTCH
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Credential | OD
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Telephone | 951-600-9226
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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 | OPT10758
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License Number State | CA
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