Provider Demographics
NPI:1962584698
Name:NG, DAVID S (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:NG
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 1:1755 WILLOW PASS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2613
Mailing Address - Country:US
Mailing Address - Phone:925-685-2767
Mailing Address - Fax:925-685-2772
Practice Address - Street 1:1755 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2613
Practice Address - Country:US
Practice Address - Phone:925-685-2767
Practice Address - Fax:925-685-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6095T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0060950Medicaid
CA0874280001Medicare NSC
CASD0060950Medicare ID - Type UnspecifiedNHIC
CASD0060950Medicaid