Individual provider Active NPI

Bruce G Flint, OD

  • Optometrist
  • Kennewick, WA
National Provider Identifier
1154438471
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00003474 Issued in WA
Practice address
6695 W Rio Grande Ave
Kennewick, WA 99336-3301
Phone
(509) 736-0826
Fax
(509) 735-6868
NPI assigned
Aug 23, 2006
Last updated
Oct 27, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00003474 WA Primary

Addresses

Primary practice location

6695 W Rio Grande Ave
Kennewick, WA 99336-3301

Mailing address

PO Box 1506
Chehalis, WA 98532-0409
Phone (360) 242-3008

Other identifiers 4

IdentifierTypeStateIssuer
410039922OtherWARAIL ROAD MEDICARE
410043345OtherIDRAIL ROAD MEDICARE
410039920OtherWARAIL ROAD MEDICARE
410039921OtherWARAIL ROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
598NMMDAdvanced Practice Midwife

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1154438471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1506",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985320409",
            "telephone_number": "360-242-3008",
            "fax_number": "360-807-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6695 W RIO GRANDE AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993363301",
            "telephone_number": "509-736-0826",
            "fax_number": "509-735-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLINT",
        "first_name": "BRUCE",
        "middle_name": "G",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410039922",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410043345",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410039920",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410039921",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.