Provider Demographics
NPI:1467542985
Name:SCHORES, DAVID O (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:SCHORES
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:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0357
Mailing Address - Country:US
Mailing Address - Phone:360-385-1093
Mailing Address - Fax:360-385-6843
Practice Address - Street 1:150 CHIMACUM RD.
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339
Practice Address - Country:US
Practice Address - Phone:360-385-1093
Practice Address - Fax:360-385-6843
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600 633 947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2097509Medicaid
WA1467542985OtherRENDERING PROVIDER
WA1801115191OtherBILLING PROVIDER NPI
WAG8891340OtherRENDERING PROVIDER PTAN
WAG000200362OtherBILLING PROVIDER PTAN
WAG000200362OtherBILLING PROVIDER PTAN
WAG000200362Medicare PIN