Active NPI
Bruce Douglas Noonan, M.D.
- Ophthalmology Physician
- Moses Lake, WA
National Provider Identifier
1902124472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD00012647
- Practice address
- 4727 Bluff Dr NE
Moses Lake, WA 98837-9075 - Phone
- (509) 766-6335
- Fax
- (509) 766-6335
- NPI assigned
- May 8, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD00012647 | WA | Primary |
| Ophthalmology Physician | 207W00000X | 8830 | OR |
Addresses
Primary practice location
4727 Bluff Dr NE
Moses Lake, WA 98837-9075
Mailing address
4727 Bluff Dr NE
Moses Lake, WA 98837-9075
Phone (509) 766-6335
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8830 | OR | MD | Ophthalmology Physician |
| MD00012647 | WA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273276800000",
"number": "1902124472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4727 BLUFF DR NE",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988379075",
"telephone_number": "509-766-6335",
"fax_number": "509-766-6335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4727 BLUFF DR NE",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988379075",
"telephone_number": "509-766-6335",
"fax_number": "509-766-6335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOONAN",
"first_name": "BRUCE",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-08",
"last_updated": "2010-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WA",
"license": "MD00012647",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "OR",
"license": "8830",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moses Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.