Davenport Vision Clinic, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0D00003248 Issued in WA

Legal business name

DAVENPORT VISION CLINIC, INC.

Practice address

506 8TH St
Davenport, WA 99122

Phone

(509) 725-2000

Fax

(509) 725-4231

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Stacie R Nichols, ODNPI 1912927518

Title

Owner

Phone

(509) 725-2000

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacie R. Nichols, O.D.

  • Optometrist
  • Davenport, WA
  • NPI 1912927518
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1447323811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991220027",
            "telephone_number": "509-725-2000",
            "fax_number": "509-725-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 8TH ST",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "99122",
            "telephone_number": "509-725-2000",
            "fax_number": "509-725-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT VISION CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "STACIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-725-2000",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "0D00003248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410046744",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2025815",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Barrett Churchwell, LMHCA
• Cassandra Ann Clark, B.A.
• Larae S. Damschen, LMP
• Davenport Family Dentistry
• Davenport School District
• Deanna D. Davidson, DO
• Dr Mobility, LLC
• James N Dunlap, M.D.
• Shannon L Dykes-Albers
• Tamra Ann Edmonds

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; 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.