MEDICARE: DR. DAVID L EAST O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OP2763	FL
2	152W00000X	Optometrist	0618002942	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20660	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1235147364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L EAST O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1290
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-1290
Country	:	US
Telephone Number	:	434-385-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 GRAVES MILL RD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-3967
Country	:	US
Telephone Number	:	434-385-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/02/2021

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