Provider Demographics
NPI:1528117462
Name:PFENNINGER, DAVID P (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:PFENNINGER
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 1:832 EAST MAIN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4316
Mailing Address - Country:US
Mailing Address - Phone:765-962-3944
Mailing Address - Fax:765-962-3944
Practice Address - Street 1:832 EAST MAIN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4316
Practice Address - Country:US
Practice Address - Phone:765-962-3944
Practice Address - Fax:765-962-3944
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001407A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN965630Medicare ID - Type Unspecified
U27581Medicare UPIN