Healthcare Provider Details

I. General information

NPI: 1700768397
Provider Name (Legal Business Name): EASTON JAMES BENTS OMS-IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 33RD ST STE 100
VANCOUVER WA
98663-2776
US

IV. Provider business mailing address

100 E 33RD ST STE 100
VANCOUVER WA
98663-2776
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7560
  • Fax:
Mailing address:
  • Phone: 360-514-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOL.OL.70137634
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: