NPIMap

Organization Active NPI

Northeastern Washington Eyecare

Doing business as Colville Vision Source

  • Optometrist
  • Newport, WA
National Provider Identifier
1629638929
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NORTHEASTERN WASHINGTON EYECARE
Doing business as
Colville Vision Source
Newport Vision Source
Practice address
205 S Washington Ave
Newport, WA 99156-9670
Phone
(509) 447-2945
NPI assigned
Jun 18, 2019
Last updated
Oct 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Authorized official

Name
Kyle Crance, ODNPI 1114372000
Title
Doctor
Phone
(509) 844-1343

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

205 S Washington Ave
Newport, WA 99156-9670

Mailing address

3109 S Dearborn LN
Spokane, WA 99223-1536
Phone (509) 670-1578

Other practice location 1

102 S Oak St
Colville, WA 99114-2846
Phone (509) 684-5278

Other names 2

  • Colville Vision Source Doing business as
  • Newport 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
O20191108002085 WA Part B Supplier - Clinic/Group Practice 3870925092 Receives reassigned benefits from 21 practitioners
Practice locations: Colville, WA; Newport, WA

National Provider Directory

National Provider Directory
Tax ID family
Northeastern Washington Eyecare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

102 S Oak St
Colville, WA 99114
Phone (509) 684-5278

205 S Washington Ave
Newport, WA 99156
Phone (509) 447-2945

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1629638929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 S DEARBORN LN",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992231536",
            "telephone_number": "509-670-1578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S WASHINGTON AVE",
            "city": "NEWPORT",
            "state": "WA",
            "postal_code": "991569670",
            "telephone_number": "509-447-2945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 S Oak St",
            "address_purpose": "LOCATION",
            "city": "Colville",
            "state": "WA",
            "postal_code": "991142846",
            "country_code": "US",
            "telephone_number": "509-684-5278",
            "fax_number": "509-684-3268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEASTERN WASHINGTON EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-18",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "CRANCE",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "509-844-1343",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colville Vision Source",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Newport Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.