Active NPI
Craig D. Mehlhoff, O.D.
- Optometrist
- Aberdeen, WA
National Provider Identifier
1811086127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OD00001382
- Practice address
- 301 N Broadway St
Aberdeen, WA 98520-3933 - Phone
- (360) 533-1880
- Fax
- (360) 533-1886
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OD00001382 | WA | Primary |
Addresses
Primary practice location
301 N Broadway St
Aberdeen, WA 98520-3933
Mailing address
PO Box 388
Aberdeen, WA 98520-0093
Phone (360) 533-1880
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27402 | Other | WA | L & I PROV. # |
| 0803129 | Other | WA | BLUECROSS |
| 1019536 | Medicaid | WA | |
| 410040935 | Other | WA | RR MEDICARE |
| ME 9095 | Other | WA | REGENCE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274313600000",
"number": "1811086127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 388",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "985200093",
"telephone_number": "360-533-1880",
"fax_number": "360-533-1886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N BROADWAY ST",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "985203933",
"telephone_number": "360-533-1880",
"fax_number": "360-533-1886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEHLHOFF",
"first_name": "CRAIG",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2010-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "OD00001382",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I PROV. #",
"identifier": "27402",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS",
"identifier": "0803129",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1019536",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "410040935",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "ME 9095",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aberdeen, 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.