Provider Demographics
NPI:1427099563
Name:STRUNK, DAVID JOHN (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:STRUNK
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 1:665 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1485
Mailing Address - Country:US
Mailing Address - Phone:321-984-3200
Mailing Address - Fax:321-984-0032
Practice Address - Street 1:250 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3495
Practice Address - Country:US
Practice Address - Phone:321-453-5700
Practice Address - Fax:321-452-5370
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19267OtherBCBS OF FLORIDA
FL078425700Medicaid
FLT84114Medicare UPIN
FL410038560Medicare PIN
FL0539980001Medicare NSC
FL0539980006Medicare NSC
FL19267OtherBCBS OF FLORIDA
FL078425700Medicaid
FL0539980005Medicare NSC
FL0539980003Medicare NSC
FL19267ZMedicare PIN