Provider Demographics
NPI:1861591638
Name:PRICE, DAVID K (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:PRICE
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 1:2108 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2947
Mailing Address - Country:US
Mailing Address - Phone:229-244-3000
Mailing Address - Fax:229-244-1934
Practice Address - Street 1:2108 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2947
Practice Address - Country:US
Practice Address - Phone:229-244-3000
Practice Address - Fax:229-244-1934
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA187346983AMedicaid
GA41ZCFQWMedicare ID - Type Unspecified
GA187346983AMedicaid