Colville Valley Eyecare, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1246 Issued in WA

Legal business name

COLVILLE VALLEY EYECARE, PLLC

Practice address

298 S Main St
Suite 301
Colville, WA 99114-2447

Phone

(509) 684-2221

Fax

(509) 684-6222

NPI assigned

Aug 9, 2012

Last updated

Aug 9, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kenton Scott McDougall, ODNPI 1245340116

Title

Owner

Phone

(509) 684-2221

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

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.

• Jonathan Wilson Harper, O.D.

  • Optometrist
  • Colville, WA
  • NPI 1104159284
  Medicare reassignment NPD
• Kenton Scott McDougall, O.D.

  • Optometrist
  • Colville, WA
  • NPI 1245340116
  Authorized official Same address or phone

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344470400000",
    "number": "1871840835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "298 S MAIN ST",
            "address_2": "SUITE 301",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142447",
            "telephone_number": "509-684-2221",
            "fax_number": "509-684-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 S MAIN ST",
            "address_2": "SUITE 301",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142447",
            "telephone_number": "509-684-2221",
            "fax_number": "509-684-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLVILLE VALLEY EYECARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-09",
        "last_updated": "2012-08-09",
        "status": "A",
        "authorized_official_last_name": "MCDOUGALL",
        "authorized_official_first_name": "KENTON",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-684-2221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60083989",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043433",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colville Medical Center PS (NorthEast Washington Medical Group (KF RHC))
• Colville Naturopathic Clinic P.S.
• Colville of Cascadia, LLC
• Colville Physical Therapy Inc
• Colville School District
• Ginger Ann Colvin, CDPT
• Compass Counseling and Clinical Supervision, PLLC
• Kristin Michelle Comstock, MD
• John Conley, PTA
• William Franklin Cooley III

• Optometrist in Colville, WA
• Providers in Colville, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; 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.