James R Hathaway, OD
Individual provider Active NPI Optometrist · Worley, ID
NPI 1164516530 · NPPES record last updated Aug 8, 2008
Key facts
- NPI
- 1164516530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3479 (WA)
- Practice address
- 22225 S Cave Bay Rd
Worley, ID 83876-7788 - Phone
- (509) 954-9856
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3479 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeview Vision Center, LLC | Optometrist | Past | Accepting new patients |
| Lake Health District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3479 | WA | Yes |
Addresses
Primary practice location
22225 S Cave Bay Rd
Worley, ID 83876-7788
Mailing address
22225 S Cave Bay Rd
Worley, ID 83876-7788
Phone (509) 954-9856
Other providers in Worley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.