Active NPI
David W Trull, OD
- Optometrist
- Fort Huachuca, AZ
National Provider Identifier
1265466940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10866T
- Practice address
- 2240 Winrow Rd
Fort Huachuca, AZ 85613-5080 - Phone
- (520) 533-9197
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 10866T | CA | Primary |
Addresses
Primary practice location
2240 Winrow Rd
Fort Huachuca, AZ 85613-5080
Mailing address
2240 Winrow Rd
Fort Huachuca, AZ 85613-7079
Phone (520) 533-9193
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0108660 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150818005807 | AZ | Order and Referring Only - Optometry | 6507875960 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10866T | CA | MD | Optometrist |
| 10866 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1265466940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2240 WINROW RD",
"city": "FORT HUACHUCA",
"state": "AZ",
"postal_code": "856137079",
"telephone_number": "520-533-9193",
"fax_number": "520-533-4766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2240 WINROW RD",
"city": "FORT HUACHUCA",
"state": "AZ",
"postal_code": "856135080",
"telephone_number": "520-533-9197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRULL",
"first_name": "DAVID",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "10866T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0108660",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Huachuca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.