Northside Vision Center, P.S.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3995TX Issued in WA

Legal business name

NORTHSIDE VISION CENTER, P.S.

Practice address

601 W Francis Ave
Spokane, WA 99205-6427

Phone

(509) 326-2772

Fax

(509) 327-1405

NPI assigned

Oct 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Chris Michael Fairborn, O.D.NPI 1134103377

Title

President

Phone

(509) 326-2772

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 3

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

• Chris M Fairborn, O.D.

  • Optometrist
  • Spokane, WA
  • NPI 1134103377
  Medicare reassignment NPD Authorized official
• Dale M. Meuler, O.D.

  • Optometrist
  • Spokane, WA
  • NPI 1205954872
  NPD (past)
• Brent Roy Phinney, O.D.

  • Optometrist
  • Windsor, CO
  • NPI 1033292982
  NPD (past)

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1598855876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W FRANCIS AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992056427",
            "telephone_number": "509-326-2772",
            "fax_number": "509-327-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W FRANCIS AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992056427",
            "telephone_number": "509-326-2772",
            "fax_number": "509-327-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE VISION CENTER, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-15",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "FAIRBORN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-326-2772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3995TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DE3597",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031219",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME#",
            "identifier": "5493150001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northside Family Medicine, P.S.
• Northside Family Physicians
• Northside Internal Medicine Associates PS
• Northside Physical Therapy PS
• Northside Physical Therapy, PS
• Northview Family Dental, PLLC
• Northwest Autism Center
• Northwest Behavioral Health Clinic
• Northwest Cardiac and Vascular Imaging, LLC
• Northwest Care Alliance, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.