NPIMap

Organization Active NPI

Vision Source of Wenatchee, PS

Doing business as Leavenworth Vision Source

  • Optometrist
  • Leavenworth, WA
National Provider Identifier
1538219787
Registry record updated Mar 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
VISION SOURCE OF WENATCHEE, PS
Doing business as
Leavenworth Vision Source
Practice address
1133 US Highway 2
Suite G
Leavenworth, WA 98826-1439
Phone
(509) 548-7379
Fax
(509) 548-4524
NPI assigned
Jan 11, 2007
Last updated
Mar 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2023

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

Authorized official

Name
Nicholas Allen DonagheyNPI 1063854479
Title
Vice President
Phone
(509) 662-9671

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 NU Primary

Addresses

Primary practice location

1133 US Highway 2
Suite G
Leavenworth, WA 98826-1439

Mailing address

1133 US Highway 2
Suite G
Leavenworth, WA 98826-1439
Phone (509) 548-7379

Other identifiers 1

IdentifierTypeStateIssuer
2023893MedicaidWA

Other names 1

  • Leavenworth Vision Source Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060201000033 WA Part B Supplier - Clinic/Group Practice 0749294536 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chelan, WA; Leavenworth, WA; Wenatchee, WA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2315107Leavenworth Vision Source1133 US Highway 2 Ste G, Leavenworth, WA 98826Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1133 US Highway 2
Ste G
Leavenworth, WA 98826
Phone (509) 548-5411

Practitioners & affiliated clinicians

Practitioners 7

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": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679702400000",
    "number": "1538219787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 US HIGHWAY 2",
            "address_2": "SUITE G",
            "city": "LEAVENWORTH",
            "state": "WA",
            "postal_code": "988261439",
            "telephone_number": "509-548-7379",
            "fax_number": "509-548-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 US HIGHWAY 2",
            "address_2": "SUITE G",
            "city": "LEAVENWORTH",
            "state": "WA",
            "postal_code": "988261439",
            "telephone_number": "509-548-7379",
            "fax_number": "509-548-4524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SOURCE OF WENATCHEE, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2023-03-25",
        "certification_date": "2023-03-25",
        "status": "A",
        "authorized_official_last_name": "DONAGHEY",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "509-662-9671"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2023893",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leavenworth Vision Source",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Leavenworth Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leavenworth, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2023; 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.