Provider Demographics
NPI:1407848476
Name:DROTZMANN, DAVID A (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:DROTZMANN
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 1:1060 W ELM AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2721
Mailing Address - Country:US
Mailing Address - Phone:541-567-6623
Mailing Address - Fax:541-564-0277
Practice Address - Street 1:1060 W ELM AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2721
Practice Address - Country:US
Practice Address - Phone:541-567-6623
Practice Address - Fax:541-564-0277
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2709T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR295499Medicaid
ORR117643Medicare ID - Type Unspecified
ORU62110Medicare UPIN