Provider Demographics
NPI:1538210844
Name:PLOOF, DAMIAN M (OD)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:M
Last Name:PLOOF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 FRONT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6734
Mailing Address - Country:US
Mailing Address - Phone:619-749-0200
Mailing Address - Fax:619-749-8434
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1480
Practice Address - Country:US
Practice Address - Phone:619-749-0200
Practice Address - Fax:619-749-8434
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist