Provider Demographics
NPI:1215190897
Name:WHITEMARSH, DAVID BURKE (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BURKE
Last Name:WHITEMARSH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 MICKELBERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8531
Mailing Address - Country:US
Mailing Address - Phone:360-692-7372
Mailing Address - Fax:
Practice Address - Street 1:9990 MICKELBERRY RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8531
Practice Address - Country:US
Practice Address - Phone:360-692-7372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60022209152W00000X
OR3275ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist