=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457606303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID L. POPPER, O.D., P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2012
-----------------------------------------------------
Last Update Date | 11/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6850 MIRAMAR PKWY
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33023-6003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-2200
-----------------------------------------------------
Fax | 954-961-7645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6850 MIRAMAR PKWY
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33023-6003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-2200
-----------------------------------------------------
Fax | 954-961-7645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID LEE POPPER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 954-961-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC2100
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------