Provider Demographics
NPI:1386766384
Name:POPPER, DAVID LEE (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:POPPER
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 1:6850 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6003
Mailing Address - Country:US
Mailing Address - Phone:954-961-2200
Mailing Address - Fax:954-961-7645
Practice Address - Street 1:6850 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6003
Practice Address - Country:US
Practice Address - Phone:954-961-2200
Practice Address - Fax:954-961-7645
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078579200Medicaid
FL078579200Medicaid
FL19915Medicare ID - Type Unspecified
FLT84226Medicare UPIN