Provider Demographics
NPI:1689674863
Name:CANTLEY, DAVID A (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:CANTLEY
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 1:112 COLUMBIA POINT DR
Mailing Address - Street 2:STE 102
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-943-6565
Mailing Address - Fax:509-946-6416
Practice Address - Street 1:112 COLUMBIA POINT DR
Practice Address - Street 2:STE 102
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4390
Practice Address - Country:US
Practice Address - Phone:509-943-6565
Practice Address - Fax:509-946-6416
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2027985Medicaid
WA167571OtherLABOR AND INDUSTRIES
WA2027985Medicaid
U22116Medicare UPIN
GAB36228Medicare PIN