Provider Demographics
NPI:1174826002
Name:DANIEL D DAVID
Entity Type:Organization
Organization Name:DANIEL D DAVID
Other - Org Name:FAMILY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-334-3300
Mailing Address - Street 1:560 SE BISHOP BLVD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5505
Mailing Address - Country:US
Mailing Address - Phone:509-334-3300
Mailing Address - Fax:509-334-7591
Practice Address - Street 1:560 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5505
Practice Address - Country:US
Practice Address - Phone:509-334-3300
Practice Address - Fax:509-334-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000096751OtherLABOR & INDUSTRIES
WA3506831OtherCIGNA
WA00010015358OtherASURIS NORTHWEST HEALTH PLAN
WA000301793OtherMEDICARE ID-TYPE UNSPECIFIED
WA2005718Medicaid
WA000503341OtherAETNA
WADAVDN5371457713OtherPREMERA BLUE CROSS
WAT02420Medicare UPIN