NPIMap

Organization Active NPI

Mower Vision Source, PLLC

Doing business as Selah Vision Clinic

  • Optometrist
  • Selah, WA
National Provider Identifier
1033517149
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD60367942 Issued in WA
Legal business name
MOWER VISION SOURCE, PLLC
Doing business as
Selah Vision Clinic
Practice address
1 Jim Clements Way
Selah, WA 98942-1437
Phone
(509) 697-2020
NPI assigned
Dec 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brett Mower, O.D.NPI 1689010811
Title
Managing Member
Phone
(509) 307-7012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OD60367942 WA Primary

Addresses

Primary practice location

1 Jim Clements Way
Selah, WA 98942-1437

Mailing address

PO Box 294
Selah, WA 98942-0294
Phone (509) 697-2020

Other practice location 1

105 W Orchard Ave
Selah, WA 98942-1329
Phone (509) 697-2020

Other names 1

  • Selah Vision Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150211001341 WA Part B Supplier - Clinic/Group Practice 8921323163 Receives reassigned benefits from 3 practitioners
Practice locations: Selah, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1033517149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 294",
            "city": "SELAH",
            "state": "WA",
            "postal_code": "989420294",
            "telephone_number": "509-697-2020",
            "fax_number": "509-697-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JIM CLEMENTS WAY",
            "city": "SELAH",
            "state": "WA",
            "postal_code": "989421437",
            "telephone_number": "509-697-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 W Orchard Ave",
            "address_purpose": "LOCATION",
            "city": "Selah",
            "state": "WA",
            "postal_code": "989421329",
            "country_code": "US",
            "telephone_number": "509-697-2020",
            "fax_number": "509-697-6659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOWER VISION SOURCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-05",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "MOWER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "509-307-7012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60367942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Selah Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Selah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.