NPIMap

Organization Active NPI

Grays Harbor Vision Clinic, Inc.

  • Clinic/Center
  • Aberdeen, WA
National Provider Identifier
1265522932
Registry record updated May 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
601 803 571 Issued in WA
Legal business name
GRAYS HARBOR VISION CLINIC, INC.
Practice address
301 N Broadway St
Aberdeen, WA 98520-3933
Phone
(360) 533-1880
Fax
(360) 533-1886
NPI assigned
Oct 13, 2006
Last updated
May 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2010

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

Authorized official

Name
Dr. Craig D. Mehlhoff, O. D.NPI 1811086127
Title
Dr./President
Phone
(360) 533-1880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 601 803 571 WA Primary

Addresses

Primary practice location

301 N Broadway St
Aberdeen, WA 98520-3933

Mailing address

PO Box 388
Aberdeen, WA 98520-0093
Phone (360) 533-1880

Other identifiers 2

IdentifierTypeStateIssuer
135989135989OtherWABLUE CROSS PROV. #
1006392MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000318 WA Part B Supplier - Clinic/Group Practice 4284523424 Receives reassigned benefits from 2 practitioners
Practice locations: Aberdeen, WA

National Provider Directory

National Provider Directory

Locations

301 N Broadway St
Aberdeen, WA 98520
Phone (360) 533-1880

301 N Broadway St
Ste 4
Aberdeen, WA 98520
Phone (360) 533-1880

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1265522932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985200093",
            "telephone_number": "360-533-1880",
            "fax_number": "360-533-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N BROADWAY ST",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985203933",
            "telephone_number": "360-533-1880",
            "fax_number": "360-533-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYS HARBOR VISION CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "MEHLHOFF",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DR./PRESIDENT",
        "authorized_official_telephone_number": "360-533-1880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O. D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "601 803 571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV. #",
            "identifier": "135989135989",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006392",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; 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.