Provider Demographics
NPI:1881701761
Name:STANFIELD, DAVID L (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:STANFIELD
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 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021345Medicaid
WA410017355OtherRAIL ROAD MEDICARE
WA410017363OtherRAIL ROAD MEDICARE
WA410045036OtherRAIL ROAD MEDICARE
WAG000165106Medicare PIN
WA410017363OtherRAIL ROAD MEDICARE
WAG001056804Medicare PIN
WAG000686622Medicare PIN
WAG000917200Medicare PIN
WAG000355057Medicare PIN