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General NPI Number Information
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NPI Number | 1902191620
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Entity Type | Individual
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Provider Name | DAVID BLACK O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 1831 E CAMELBACK RD STE B2
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City | PHOENIX
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State | AZ
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Zip | 85016-4162
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Country | US
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Telephone | 602-234-7904
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Fax | 602-875-0248
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Provider Business Mailing Address
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Address Line | 7333 W THOMAS RD STE 18
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City | PHOENIX
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State | AZ
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Zip | 85033-5547
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Country | US
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Telephone | 623-247-0777
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Fax | 623-849-1283
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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 | 1776
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License Number State | AZ
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