Basic Information
Provider Information
NPI: 1912978552
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCLAREN
FirstName: DAVID
MiddleName: BRIAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 34520 BOB WILSON DR
Address2: DEPT OF OPHTHALMOLOGY
City: SAN DIEGO
State: CA
PostalCode: 921342098
CountryCode: US
TelephoneNumber: 6195326702
FaxNumber: 6195327272
Practice Location
Address1: 34520 BOB WILSON DR
Address2: DEPT OF OPHTHALMOLOGY
City: SAN DIEGO
State: CA
PostalCode: 921342098
CountryCode: US
TelephoneNumber: 6195326702
FaxNumber: 6195327272
Other Information
ProviderEnumerationDate: 01/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XG82153CAY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


Home