Kellie Jaclyn Ross-Chavez, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60758608 Issued in WA

Practice address

19171 SE Mill Plain Blvd Ste 101
Vancouver, WA 98683-9321

Phone

(360) 883-8889

NPI assigned

Apr 12, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1376907626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 SE 12TH AVE",
            "address_2": "APT 204",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "98604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19171 SE MILL PLAIN BLVD STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839321",
            "telephone_number": "360-883-8889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29570 Water St",
            "address_purpose": "LOCATION",
            "city": "Highland",
            "state": "CA",
            "postal_code": "923463949",
            "country_code": "US",
            "telephone_number": "909-957-4279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSS-CHAVEZ",
        "first_name": "KELLIE",
        "middle_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60758608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Joy Rosenberg, MSW, ASW
• Nevin M Rosenberg, D.C.
• Keren Rosenblum, MD
• Bonnie L. Rosenfeld, P.A.-C.
• Sherrill J Roskam, NNP
• Brittney Ellen Ross, PT
• David Opollo Ross, PSYD
• Debra Anne Ross
• Jennifer Ross, MS, SLP
• Jonerik Ross

• Optometrist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.