Provider Demographics
NPI:1386692341
Name:DAVID S FORREST OD PA
Entity type:Organization
Organization Name:DAVID S FORREST OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SHEPARD
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-332-5332
Mailing Address - Street 1:11300 NW 87TH CT
Mailing Address - Street 2:#115
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4586
Mailing Address - Country:US
Mailing Address - Phone:305-332-5332
Mailing Address - Fax:
Practice Address - Street 1:11300 NW 87TH CT
Practice Address - Street 2:#115
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4586
Practice Address - Country:US
Practice Address - Phone:305-332-5332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20614Medicare ID - Type UnspecifiedOPTOMETRIST