Healthcare Provider Details

I. General information

NPI: 1154117646
Provider Name (Legal Business Name): DOMINIQUE D RIVERS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 NE KRESKY AVE
CHEHALIS WA
98532-2409
US

IV. Provider business mailing address

PO BOX 1506
CHEHALIS WA
98532-0409
US

V. Phone/Fax

Practice location:
  • Phone: 360-748-8632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.70135768
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6581223
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: