Individual provider Active NPI

Michael C Noble, OPTOMETRIC DOCTOR

  • Optometrist
  • Yakima, WA
National Provider Identifier
1386697266
Registry record updated Dec 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00001563 Issued in WA
Practice address
1211 S 40TH Ave
Yakima, WA 98908-3961
Phone
(509) 966-2966
Fax
(509) 966-3230
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00001563 WA Primary
Optometrist 152W00000X 1651D OR

Addresses

Primary practice location

1211 S 40TH Ave
Yakima, WA 98908-3961

Mailing address

1211 S 40TH Ave
Yakima, WA 98908-3961
Phone (509) 966-2966

Other identifiers 2

IdentifierTypeStateIssuer
NO1023OtherWAREGENCE BLUE SHIELD
2015485MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1651DORMDOptometrist
OD00001563WAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261094400000",
    "number": "1386697266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083961",
            "telephone_number": "509-966-2966",
            "fax_number": "509-966-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083961",
            "telephone_number": "509-966-2966",
            "fax_number": "509-966-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBLE",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "OPTOMETRIC DOCTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2009-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001563",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1651D",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "NO1023",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015485",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.