MEDICARE: DAVID ALONSO, OD A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1982084554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID ALONSO, OD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3050 W CAMP WISDOM RD
Second Line	:	SUITE 140
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 W CAMP WISDOM RD
Second Line	:	SUITE 140
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4642
Country	:	US
Telephone Number	:	214-718-8447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID ALONSO
Credential	:	OD
Telephone Number	:	214-718-8447

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	12/30/2015

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