NPIMap

Organization Active NPI

The Vancouver Clinic Inc PS

Doing business as The Vancouver clinic

  • Eyewear Supplier
  • Camas, WA
National Provider Identifier
1609483429
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
THE VANCOUVER CLINIC INC PS
Doing business as
The Vancouver clinic
Practice address
4500 SE Columbia Palisades Dr
Camas, WA 98607-8444
Phone
(360) 882-2778
Fax
(360) 604-1780
NPI assigned
Sep 25, 2020
Last updated
Sep 25, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
THE VANCOUVER CLINIC INC PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

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

Authorized official

Name
Julie A Barry
Title
Credentialing Coordinator
Phone
(360) 397-3352

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

4500 SE Columbia Palisades Dr
Camas, WA 98607-8444

Mailing address

700 NE 87TH Ave
Vancouver, WA 98664-4896
Phone (360) 882-2778

Other identifiers 1

IdentifierTypeStateIssuer
1046502MedicaidWA

Other names 1

  • The Vancouver clinic Doing business as

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
50D2196473The Vancouver Clinic - Camas4500 SE Columbia Palisades Dr, Camas, WA 98607ComplianceApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Vancover Clinic Inc7 organizations share this tax ID, including this one
Part of
Vancover Clinic Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1609483429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986644896",
            "telephone_number": "360-882-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SE COLUMBIA PALISADES DR",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986078444",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VANCOUVER CLINIC INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE VANCOUVER CLINIC INC PS",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "BARRY",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "360-397-3352"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1046502",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Vancouver clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camas, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.