NPIMap

Organization Active NPI

Spokane Optical Company LLC

  • Eyewear Supplier
  • Spokane, WA
National Provider Identifier
1386992717
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
602617024 Issued in WA
Legal business name
SPOKANE OPTICAL COMPANY LLC
Doing business as
Spokane Optical Company LLC
Practice address
9651 N Nevada St
Spokane, WA 99218
Phone
(509) 489-1272
Fax
(509) 489-8756
NPI assigned
Aug 15, 2012
Last updated
Jul 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Authorized official

Name
Dr. Randall K Jacobson, M.D.NPI 1962400135
Title
Physician
Phone
(509) 456-0107

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
Eyewear Supplier 332H00000X 602617024 WA Primary

Addresses

Primary practice location

9651 N Nevada St
Spokane, WA 99218

Mailing address

427 S Bernard St
Spokane, WA 99204-2509
Phone (509) 456-0107

Other practice location 1

31 E Central Ave
Spokane, WA 99208-1164
Phone (509) 489-1270

Other names 1

  • Spokane Optical Company LLC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Spokane Eye Clinic9651 N Nevada St, Spokane, WA 99218-1132(509) 456-0107 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

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": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1386992717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 S BERNARD ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042509",
            "telephone_number": "509-456-0107",
            "fax_number": "509-747-2635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9651 N NEVADA ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99218",
            "telephone_number": "509-489-1272",
            "fax_number": "509-489-8756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 E Central Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992081164",
            "country_code": "US",
            "telephone_number": "509-489-1270",
            "fax_number": "509-483-6547",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPOKANE OPTICAL COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "509-456-0107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WA",
            "license": "602617024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spokane Optical Company LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spokane Optical Company LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.