1528131398 NPI number — DR DUANE L RANA P S

Table of content: (NPI 1528131398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528131398 NPI number — DR DUANE L RANA P S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR DUANE L RANA P S
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528131398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98812-0578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-689-3220
Provider Business Mailing Address Fax Number:
509-689-9207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 HOSPITAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98812-0578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-689-3220
Provider Business Practice Location Address Fax Number:
509-689-9207
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANA
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OPTOMETRIST-OWNER
Authorized Official Telephone Number:
509-689-3220

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD00001256 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2013522 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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