Provider Demographics
NPI:1992130678
Name:DAVID GAIMARI OD PS
Entity type:Organization
Organization Name:DAVID GAIMARI OD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-487-5456
Mailing Address - Street 1:318 E ROWAN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1200
Mailing Address - Country:US
Mailing Address - Phone:509-487-5456
Mailing Address - Fax:509-484-0082
Practice Address - Street 1:318 E ROWAN AVE STE 207
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1200
Practice Address - Country:US
Practice Address - Phone:509-487-5456
Practice Address - Fax:509-484-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003794261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1022667Medicaid