Individual provider Active NPI

Robert D Davis, O.D.

  • Optometrist
  • Ellensburg, WA
National Provider Identifier
1962578187
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00003210 Issued in WA
Practice address
2201 W Dolarway Rd Ste 2
Ellensburg, WA 98926-8228
Phone
(509) 925-1000
Fax
(509) 925-2474
NPI assigned
Nov 28, 2006
Last updated
Feb 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00003210 WA Primary

Addresses

Primary practice location

2201 W Dolarway Rd Ste 2
Ellensburg, WA 98926-8228

Mailing address

3910 Riverbottom Rd
Ellensburg, WA 98926-8932
Phone (509) 933-3263

Other identifiers 1

IdentifierTypeStateIssuer
2023323MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070709000150 WA Practitioner - Optometry 8527168483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Vision Associates LLPGroup PAC ID 8729187893, 6 clinicians

Practice addresses (Care Compare)

2201 W Dolarway Rd
Suite 2
Ellensburg, WA 98926-8228
Phone (509) 925-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
43.3 of 100Reported as individual
Quality
51.46
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ellensburg Eye and Contact Lens Clinic Optometrist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1962578187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 RIVERBOTTOM RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989268932",
            "telephone_number": "509-933-3263",
            "fax_number": "509-925-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 W DOLARWAY RD STE 2",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989268228",
            "telephone_number": "509-925-1000",
            "fax_number": "509-925-2474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "ROBERT",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2023323",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellensburg, WA

Sources for this page

Verify at the official NPI Registry.