Provider Demographics
NPI:1740275569
Name:DAVID, DANIEL D
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:DAVID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010015358OtherASURIS NORTHWEST HEALTH
000503341OtherAETNA
WA2005718Medicaid
3506831OtherCIGNA
DAVDN5371457713OtherPREMERA BLUE CROSS
WA000096751OtherLABOR & INDUSTRIES
WA0252660002Medicare NSC
3506831OtherCIGNA
00010015358OtherASURIS NORTHWEST HEALTH