Provider Demographics
NPI:1841277472
Name:KORDISH, DAVID S (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:KORDISH
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 1:12209 E MISSION AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4824
Mailing Address - Country:US
Mailing Address - Phone:509-443-3145
Mailing Address - Fax:509-443-3968
Practice Address - Street 1:12209 E MISSION AVE STE 9
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4824
Practice Address - Country:US
Practice Address - Phone:509-443-3145
Practice Address - Fax:509-443-3968
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1375OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012896Medicaid
WA48854OtherL & I
WA2012896Medicaid
U23800Medicare UPIN