Provider Demographics
NPI:1912728643
Name:WEINSTEIN, DAVID HOWARD
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARD
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S PINTO DR
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6281
Mailing Address - Country:US
Mailing Address - Phone:480-414-5682
Mailing Address - Fax:480-855-0298
Practice Address - Street 1:1040 S GILBERT RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3470
Practice Address - Country:US
Practice Address - Phone:480-893-8776
Practice Address - Fax:480-855-0298
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ838156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician