NPIMap

Organization Active NPI

Center Vision & Contact Lens Clinic Inc P S

  • Optometrist
  • Kennewick, WA
National Provider Identifier
1730132085
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CENTER VISION & CONTACT LENS CLINIC INC P S
Practice address
8127 W Grandridge Blvd
Suite 110
Kennewick, WA 99336-7166
Phone
(509) 783-8383
Fax
(509) 735-2592
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Authorized official

Name
Dr. Aaron M Banta, ODNPI 1831166891
Title
Co Owner
Phone
(509) 783-8383

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
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

8127 W Grandridge Blvd
Suite 110
Kennewick, WA 99336-7166

Mailing address

8127 W Grandridge Blvd
Suite 110
Kennewick, WA 99336-7166
Phone (509) 783-8383

Other names 1

  • Center Vision Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040517000877 WA Part B Supplier - Clinic/Group Practice 8325038789 Receives reassigned benefits from 4 practitioners
Practice locations: Kennewick, WA
O20100930001606 WA DME Supplier - Physician - Optometrist 8325038789 Practice locations: Kennewick, WA

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
50D2112865Center Vision Clinic8127 W Grandridge Blvd Ste 110, Kennewick, WA 99336Certificate of waiverApr 4, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Center Vision & Contact Lens Clinic8127 W Grandridge Blvd, Kennewick, WA 99336-7166(509) 783-8383 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

4015 W Clearwater Ave
Kennewick, WA 99336
Phone (509) 736-4005

8127 W Grandridge Blvd
#110
Kennewick, WA 99336
Phone (509) 279-2176

Practitioners & affiliated clinicians

Practitioners 4

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469059200000",
    "number": "1730132085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8127 W GRANDRIDGE BLVD",
            "address_2": "SUITE 110",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367166",
            "telephone_number": "509-783-8383",
            "fax_number": "509-735-2592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8127 W GRANDRIDGE BLVD",
            "address_2": "SUITE 110",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367166",
            "telephone_number": "509-783-8383",
            "fax_number": "509-735-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER VISION & CONTACT LENS CLINIC INC P S",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-07-21",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "509-783-8383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.