Provider Demographics
NPI:1154342566
Name:CARLTON, DAVID DONALD (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DONALD
Last Name:CARLTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 S GLENDORA AVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741
Mailing Address - Country:US
Mailing Address - Phone:626-335-4021
Mailing Address - Fax:626-335-9910
Practice Address - Street 1:410 S GLENDORA AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6207
Practice Address - Country:US
Practice Address - Phone:626-335-4021
Practice Address - Fax:626-335-9910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06254T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP6254CMedicare PIN