Organization
DAVID O. SCHORES OD INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAM LONG (ACCOUNTS MGR)
(360) 385-1093
Entity
Organization
Contact information
Practice address
150 CHIMACUM RD, PORT HADLOCK, WA 98339-9774
(360) 385-1093
(360) 385-6843
Mailing address
150 CHIMACUM ROAD, PO BOX 357, PORT HADLOCK, WA 98339-9774
(360) 385-1093
(360) 385-6843
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00001571
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011175
—
WA
01
—
1467542985
RENDERING PROVIDER NPI
WA
01
—
1801115191
BILLING PROVIDER NPI
WA
01
—
DQ2827
RAIL ROAD MEDICARE
WA
01
—
G000200362
BILLING PROVIDER PTAN
WA
01
—
G8891340
RENDERING PROVIDER PTAN
WA
Enumeration date
05/26/2010
Last updated
07/15/2010
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