Individual provider Active NPI

John P Rundle, MD

  • Ophthalmology Physician
  • Vancouver, WA
National Provider Identifier
1184699746
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD00010095 Issued in WA
Practice address
3200 Main Street
Vancouver, WA 98663
Phone
(360) 696-4691
Fax
(360) 823-2260
NPI assigned
Feb 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD06391 OR
Ophthalmology Physician 207W00000X MD00010095 WA Primary

Addresses

Primary practice location

3200 Main Street
Vancouver, WA 98663

Mailing address

PO Box 61896
Vancouver, WA 98666-1896
Phone (360) 823-2012

Other identifiers 1

IdentifierTypeStateIssuer
8196701MedicaidWA

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD06391ORMDOphthalmology Physician

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1184699746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61896",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986661896",
            "telephone_number": "360-823-2012",
            "fax_number": "360-823-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MAIN STREET",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98663",
            "telephone_number": "360-696-4691",
            "fax_number": "360-823-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNDLE",
        "first_name": "JOHN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD06391",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00010095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8196701",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; 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.