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General NPI Number Information
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NPI Number | 1760576987
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Entity Type | Individual
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Provider Name | DAVID CLYDE OLIVE O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 2415 MOORES MILL RD
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City | AUBURN
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State | AL
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Zip | 36830-8480
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Country | US
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Telephone | 334-521-7944
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Fax | 334-521-7277
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Provider Business Mailing Address
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Address Line | 1950 OLD GALLOWS RD STE 520
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City | VIENNA
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State | VA
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Zip | 22182-3970
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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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 | S-931-TA-494
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License Number State | AL
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