Provider Demographics
NPI:1073509899
Name:OMORCHOE, DAVID JC (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JC
Last Name:OMORCHOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20669 BOND RD NE
Mailing Address - Street 2:STE 100
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6525
Mailing Address - Country:US
Mailing Address - Phone:360-779-2020
Mailing Address - Fax:360-779-3093
Practice Address - Street 1:20669 BOND RD NE
Practice Address - Street 2:STE 100
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6525
Practice Address - Country:US
Practice Address - Phone:360-779-2020
Practice Address - Fax:360-779-3093
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00029555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1086461Medicaid
WA1086461Medicaid