MEDICARE: DANIEL D DAVID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD00001643	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00010015358	OTHER		ASURIS NORTHWEST HEALTH
2	000503341	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3506831	OTHER		CIGNA
5	DAVDN5371457713	OTHER		PREMERA BLUE CROSS
6	000096751	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1740275569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL D DAVID

Provider Business Mailing Address
First Line	:	560 SE BISHOP BLVD
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5505
Country	:	US
Telephone Number	:	509-334-3300
Fax Number	:	509-334-7591

Provider Business Practice Location Address
First Line	:	560 SE BISHOP BLVD
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5505
Country	:	US
Telephone Number	:	509-334-3300
Fax Number	:	509-334-7591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/15/2013

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Directions to “ DANIEL D DAVID ” Practice Location

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