Healthcare Provider Details

I. General information

NPI: 1467542985
Provider Name (Legal Business Name): DAVID O SCHORES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHIMACUM RD.
PORT HADLOCK WA
98339
US

IV. Provider business mailing address

PO BOX 357
PORT HADLOCK WA
98339-0357
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-1093
  • Fax: 360-385-6843
Mailing address:
  • Phone: 360-385-1093
  • Fax: 360-385-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number600 633 947
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: