Healthcare Provider Details

I. General information

NPI: 1801115191
Provider Name (Legal Business Name): DAVID O. SCHORES OD INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHIMACUM RD
PORT HADLOCK WA
98339-9774
US

IV. Provider business mailing address

150 CHIMACUM ROAD PO BOX 357
PORT HADLOCK WA
98339-9774
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 NumberOD00001571
License Number StateWA

VIII. Authorized Official

Name: MS. SAM LONG
Title or Position: ACCOUNTS MGR
Credential:
Phone: 360-385-1093