Nico Rouse Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00003743 Issued in WA

Legal business name

NICO ROUSE CORPORATION

Practice address

2202 Liggett Avenue
Fort Lewis, WA 98433-9500

Phone

(253) 964-4140

Fax

(253) 964-1696

NPI assigned

Sep 20, 2007

Last updated

Apr 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Craig Forrest RouseNPI 1720021330

Title

President

Phone

(360) 790-1669

Specialties & licenses 3

Addresses

Other identifiers 4

Practitioners 1

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.

• Craig Rouse

  • Optometrist
  • Lacey, WA
  • NPI 1720021330
  Authorized official Same address or phone

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1417143728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9321 MILBURN LOOP SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985133420",
            "telephone_number": "360-790-1669",
            "fax_number": "360-456-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 LIGGETT AVENUE",
            "city": "FORT LEWIS",
            "state": "WA",
            "postal_code": "984339500",
            "telephone_number": "253-964-4140",
            "fax_number": "253-964-1696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICO ROUSE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "ROUSE",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "FORREST",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-790-1669",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003743",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00004138",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003984",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P00327511  DE9528",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7283193",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "4536RO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3183314",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Moore
• National Vision, Inc.
• National Vision, Inc. (Ft. Lewis Optometry Clinic)
• National Vision, Inc.
• Alisha Neloms
• J. Charlene Perryman, PSYD
• Clea Peterson, RDH
• Joel T. Postma, OD
• Greg Michael Reger, PHD
• Emma Marie Ridenhour

• Optometrist in Fort Lewis, WA
• Providers in Fort Lewis, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.