NPIMap

Organization Active NPI

Jeffrey S. Nevitt OD

  • Optometrist
  • Raymond, WA
National Provider Identifier
1598042863
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD 00001562 Issued in WA
Legal business name
JEFFREY S. NEVITT OD
Practice address
500 Willapa PL
Raymond, WA 98577-2507
Phone
(360) 942-5501
Fax
(360) 942-5849
NPI assigned
Nov 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Authorized official

Name
Dr. Jeffrey S Nevitt, OD
Title
Owner
Phone
(360) 942-5501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OD 00001562 WA Primary

Addresses

Primary practice location

500 Willapa PL
Raymond, WA 98577-2507

Mailing address

500 Willapa PL
Raymond, WA 98577-2507
Phone (360) 942-5501

Other identifiers 5

IdentifierTypeStateIssuer
0128360OtherWALABOR & INDUSTRIES
N1523OtherWAPREMERA BLUE CROSS
1090708MedicaidWA
B00298624OtherWATRICARE
NE6969OtherWAREGENCE BLUE SHIELD

Other names 1

  • PACIFIC EYE CLINIC Doing business as

National Provider Directory

National Provider Directory

Locations

500 Willapa Pl
Raymond, WA 98577
Phone (360) 942-5501

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1598042863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WILLAPA PL",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985772507",
            "telephone_number": "360-942-5501",
            "fax_number": "360-942-5849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WILLAPA PL",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985772507",
            "telephone_number": "360-942-5501",
            "fax_number": "360-942-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY S. NEVITT OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "NEVITT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-942-5501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD 00001562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0128360",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "N1523",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1090708",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "B00298624",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "NE6969",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACIFIC EYE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raymond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.