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NPI Code Detail

MEDICARE: DAMIAN GORMLEY O.D.

MEDICARE:   DAMIAN  GORMLEY  O.D.
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
1152W00000XOptometristOD00001975WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2OD00001975OTHERWAWA STATE LICENSE NUMBER

General Provider Information

NPI Number : 1881773950
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMIAN GORMLEY O.D.
Provider Business Mailing Address
First Line : 5417 47TH AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98136-1148
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4555 CALIFORNIA AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4110
Country : US
Telephone Number : 206-932-8276
Fax Number : 206-937-2849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 07/08/2007

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