Active NPI
Gregory A Webster, OD
- Optometrist
- Kelso, WA
National Provider Identifier
1689660128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1025
- Practice address
- 1704 Allen St
Kelso, WA 98626-4907 - Phone
- (360) 577-0606
- Fax
- (360) 636-2986
- NPI assigned
- Sep 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1025 | WA | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 1025 | WA | |
| Pediatric Optometrist | 152WP0200X | 1025 | WA | |
| Sports Vision Optometrist | 152WS0006X | 1025 | WA | |
| Occupational Vision Optometrist | 152WX0102X | 1025 | WA |
Addresses
Primary practice location
1704 Allen St
Kelso, WA 98626-4907
Mailing address
PO Box 729
Kelso, WA 98626-0062
Phone (360) 577-0606
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1016328 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1025 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274313600000",
"number": "1689660128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 729",
"city": "KELSO",
"state": "WA",
"postal_code": "986260062",
"telephone_number": "360-577-0606",
"fax_number": "360-636-2986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1704 ALLEN ST",
"city": "KELSO",
"state": "WA",
"postal_code": "986264907",
"telephone_number": "360-577-0606",
"fax_number": "360-636-2986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEBSTER",
"first_name": "GREGORY",
"middle_name": "A",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2010-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "1025",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "WA",
"license": "1025",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "WA",
"license": "1025",
"primary": false
},
{
"code": "152WS0006X",
"taxonomy_group": "",
"desc": "Optometrist, Sports Vision",
"state": "WA",
"license": "1025",
"primary": false
},
{
"code": "152WX0102X",
"taxonomy_group": "",
"desc": "Optometrist, Occupational Vision",
"state": "WA",
"license": "1025",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1016328",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kelso, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.