MEDICARE: DAVID S KORDISH 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
1	152W00000X	Optometrist	1375OD	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	48854	OTHER	WA	L & I

General Provider Information

NPI Number	:	1841277472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID S KORDISH O.D.

Provider Business Mailing Address
First Line	:	12209 E MISSION AVE STE 9
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4824
Country	:	US
Telephone Number	:	509-443-3145
Fax Number	:	509-443-3968

Provider Business Practice Location Address
First Line	:	12209 E MISSION AVE STE 9
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4824
Country	:	US
Telephone Number	:	509-443-3145
Fax Number	:	509-443-3968

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	01/22/2019

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