Selah Vision Source, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2610001320 Issued in WA

Legal business name

SELAH VISION SOURCE, PLLC

Doing business as

Selah Vision Clinic

Practice address

105 W Orchard Ave
Selah, WA 98942-1329

Phone

(509) 697-6177

Fax

(509) 697-6659

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Nancy S Graf

Title

Projects Manager

Phone

(509) 697-6177

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Selah Vision Clinic Doing business as

Practitioners 2

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

• Brett Mower, OD

  • Optometrist
  • Selah, WA
  • NPI 1689010811
  NPD (past)
• Aaron D Qunell, O.D.

  • Optometrist
  • Selah, WA
  • NPI 1477558336
  NPD (past)

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1487787511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W ORCHARD AVE",
            "city": "SELAH",
            "state": "WA",
            "postal_code": "989421329",
            "telephone_number": "509-697-6177",
            "fax_number": "509-697-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W ORCHARD AVE",
            "city": "SELAH",
            "state": "WA",
            "postal_code": "989421329",
            "telephone_number": "509-697-6177",
            "fax_number": "509-697-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELAH VISION SOURCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "GRAF",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PROJECTS MANAGER",
        "authorized_official_telephone_number": "509-697-6177",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "2610001320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "17129",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2051902",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I CRIME VICTIMS",
            "identifier": "8905978",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBI #",
            "identifier": "C 600 340 4768",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Selah Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Sears, PTA
• Selah Convalescent, Inc.
• Selah Family Chiropractic P.S.
• Selah Medical Center Inc.
• Selah School District
• Selah's Smiles Dental, LLC
• Diana Smigaj, M.D.
• Avena M Smith
• Breanne Nicole Smith, CP60896258
• Manuela G Soria

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.