NPIMap

Organization Active NPI

Innovations in Eyecare Inc.

  • Optometrist
  • Centralia, WA
National Provider Identifier
1417193913
Registry record updated Aug 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1421 Issued in WA
Legal business name
INNOVATIONS IN EYECARE INC.
Practice address
1125 Mellen St
Centralia, WA 98531-1173
Phone
(360) 736-7385
Fax
(360) 736-8568
NPI assigned
Jan 5, 2009
Last updated
Aug 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2011

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

Authorized official

Name
Dr. Joseph L. Dolezal, O.D.NPI 1629117023
Title
President
Phone
(360) 736-7385

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1421 WA Primary

Addresses

Primary practice location

1125 Mellen St
Centralia, WA 98531-1173

Mailing address

1125 Mellen St
Centralia, WA 98531-1173
Phone (360) 736-7385

Other identifiers 2

IdentifierTypeStateIssuer
2005916MedicaidWA
DR4454OtherWARAILROAD MEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090211000860 WA Part B Supplier - Clinic/Group Practice 0143385807 Receives reassigned benefits from 1 practitioner
Practice locations: Centralia, WA
O20101027000542 WA DME Supplier - Physician - Optometrist 0143385807 Practice locations: Centralia, WA

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
Innovations in Eyecare1125 Mellen St, Centralia, WA 98531-1173(360) 736-7385 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 23, 2009

National Provider Directory

National Provider Directory

Locations

1125 Mellen St
Centralia, WA 98531
Phone (360) 736-7385

Practitioners & affiliated clinicians

Practitioners 2

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": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313020800000",
    "number": "1417193913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 MELLEN ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311173",
            "telephone_number": "360-736-7385",
            "fax_number": "360-736-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 MELLEN ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311173",
            "telephone_number": "360-736-7385",
            "fax_number": "360-736-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIONS IN EYECARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2011-08-11",
        "status": "A",
        "authorized_official_last_name": "DOLEZAL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-736-7385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2005916",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DR4454",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.