Provider Demographics
NPI:1104942911
Name:MATSUYAMA, DAVID ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:MATSUYAMA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BRISTOL ST N STE 29
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8917
Mailing Address - Country:US
Mailing Address - Phone:949-476-2870
Mailing Address - Fax:949-476-3087
Practice Address - Street 1:1000 BRISTOL ST N STE 29
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8917
Practice Address - Country:US
Practice Address - Phone:949-476-2870
Practice Address - Fax:949-476-3087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 7991T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP7991Medicare UPIN