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1245496744 NPI Number Info

healthcare provider npi status:  active since 08/04/2008

DORIAN MAX RAMMELL O.D.

Most Relevant Information

Provider Data
NPI Number 1245496744
Provider Name DORIAN MAX RAMMELL O.D.
Entity Type Individual

Most Important Dates
Provider Enumeration Date 08/04/2008
Last Updated 06/01/2010

Provider Practice Location

500 PORT DR
CLARKSTON
WA
99403-1835
US

Practice Location Phone/Fax
Phone 509-758-8811
Fax 509-751-1188

Provider Mailing Address

500 PORT DR
CLARKSTON
WA
99403-1835
US

Mailing Location Phone/Fax
Phone 509-758-8811
Fax 509-751-1188

Authorized Official
Title or Position N/S
Authorized Official Name N/S
Credentials N/S  
Telephone Number N/S
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Detailed Information

NPI Number 1245496744 has the "Individual" type of ownership and has been registered to the following primary business legal name (which is a provider name or healthcare organization name) — DORIAN MAX RAMMELL O.D.. Records indicate that the provider gender is "Male".

The enumeration date of this NPI Number is 08/04/2008.
NPI Number information was last time updated on 06/01/2010.

The provider is physically located at:

500 PORT DR
CLARKSTON, WA
99403-1835, US

DORIAN MAX RAMMELL O.D. can be reached at the following phone number(s):

Phone:  509-758-8811
Fax:  509-751-1188

The provider's official mailing address is:

500 PORT DR
CLARKSTON, WA
99403-1835, US

The contact numbers associated with the mailing address are:

Phone:  509-758-8811
Fax:  509-751-1188

Scope of Practice (Taxonomy)

# Primary Taxonomy Code Taxonomy Specialty License Number License State
1 Y 152W00000X Optometrist OD 60108608 WA
2 N 152W00000X Optometrist 3114-035 WI

Legacy (Non-NPI) Identifiers

(For crosswalk purposes, the following (non-NPI) identifiers are available for this provider)

# Provider Identifier Identifier Type Identifier State Issuer
1 0252321 OTHER WA LABOR & INDUSTRY
2 2035350 PIN MEDICAID WA
3 808328900 GRP MEDICAID ID
4 P00775620 OTHER WA RAILROAD MEDICARE
5 OD 60108608 OTHER WA STATE LICENSE
6 000010174293 OTHER ID REGENCE BLUE SHIELD CLARKSTON
7 000010174294 OTHER ID REGENCE BLUE SHIELD PULLMAN
8 00010174293 OTHER FEDERAL BLUE CROSS
9 0252321 OTHER WA CRIME VICTIMS COMPENSATION ACT
10 1245496744 OTHER ID BLUE CROSS OF IDAHO
11 2031565 GRP MEDICAID WA
12 1022RA OTHER ASURIS
13 808565801 PULL MEDICAID ID
14 808565800 CLK MEDICAID ID
15 1245496744 OTHER WA PREMERA BLUE CROSS

Legacy & Proprietary Identifiers Ever Reported To NPPES

(Collection of legacy and proprietary (non-NPI) identifiers ever reported for this provider)

# Provider Identifier Identifier Type Identifier State Issuer
1 000010174293 OTHER ID REGENCE BLUE SHIELD CLARKSTON
2 000010174294 OTHER ID REGENCE BLUE SHIELD PULLMAN
3 00010174293 OTHER FEDERAL BLUE CROSS
4 0252321 OTHER WA CRIME VICTIMS COMPENSATION ACT
5 0252321 OTHER WA LABOR & INDUSTRY
6 1022RA OTHER ASURIS
7 1245496744 OTHER ID BLUE CROSS OF IDAHO
8 1245496744 OTHER WA PREMERA BLUE CROSS
9 2031565 GRP MEDICAID WA
10 2035350 PIN MEDICAID WA
11 808328900 GRP MEDICAID ID
12 808565800 CLK MEDICAID ID
13 808565801 PULL MEDICAID ID
14 OD 60108608 OTHER WA STATE LICENSE
15 P00775620 OTHER WA RAILROAD MEDICARE

Reference NPI Information. Full Replica of the CMS (NPPES) NPI Record

Field Name Field Value
NPI 1245496744
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor N
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) RAMMELL
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name DORIAN
The first name of the provider, if the provider is an individual.
Provider Middle Name MAX
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text O.D.
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 500 PORT DR
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name CLARKSTON
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name WA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 99403-1835
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number 509-758-8811
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider Business Mailing Address Fax Number 509-751-1188
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider First Line Business Practice Location Address 500 PORT DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name CLARKSTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name WA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 99403-1835
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 509-758-8811
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number 509-751-1188
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date 08/04/2008
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 06/01/2010
The date that a record was last updated or changed.
Provider Gender Code M
The code designating the provider's gender if the provider is a person.
Provider Gender Male
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 152W00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 Optometrist
Healthcare Provider Taxonomy #1
Provider License Number 1 3114-035
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 WI
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2 152W00000X
Healthcare Provider Taxonomy Code #2
Healthcare Provider Taxonomy 2 Optometrist
Healthcare Provider Taxonomy #2
Provider License Number 2 OD 60108608
Provider License Number #2
Provider License Number State Code 2 WA
Provider License Number State Code #2
Healthcare Provider Primary Taxonomy Switch 2 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1 0252321
Other Provider Identifier #1
Other Provider Identifier Type 1 OTHER
Other Provider Identifier Type #1
Other Provider Identifier State 1 WA
Other Provider Identifier State #1
Other Provider Identifier Issuer 1 LABOR & INDUSTRY
Other Provider Identifier Issuer #1
Other Provider Identifier 2 2035350 PIN
Other Provider Identifier #2
Other Provider Identifier Type 2 MEDICAID
Other Provider Identifier Type #2
Other Provider Identifier State 2 WA
Other Provider Identifier State #2
Other Provider Identifier 3 808328900 GRP
Other Provider Identifier #3
Other Provider Identifier Type 3 MEDICAID
Other Provider Identifier Type #3
Other Provider Identifier State 3 ID
Other Provider Identifier State #3
Other Provider Identifier 4 P00775620
Other Provider Identifier #4
Other Provider Identifier Type 4 OTHER
Other Provider Identifier Type #4
Other Provider Identifier State 4 WA
Other Provider Identifier State #4
Other Provider Identifier Issuer 4 RAILROAD MEDICARE
Other Provider Identifier Issuer #4
Other Provider Identifier 5 OD 60108608
Other Provider Identifier #5
Other Provider Identifier Type 5 OTHER
Other Provider Identifier Type #5
Other Provider Identifier State 5 WA
Other Provider Identifier State #5
Other Provider Identifier Issuer 5 STATE LICENSE
Other Provider Identifier Issuer #5
Other Provider Identifier 6 000010174293
Other Provider Identifier #6
Other Provider Identifier Type 6 OTHER
Other Provider Identifier Type #6
Other Provider Identifier State 6 ID
Other Provider Identifier State #6
Other Provider Identifier Issuer 6 REGENCE BLUE SHIELD CLARKSTON
Other Provider Identifier Issuer #6
Other Provider Identifier 7 000010174294
Other Provider Identifier #7
Other Provider Identifier Type 7 OTHER
Other Provider Identifier Type #7
Other Provider Identifier State 7 ID
Other Provider Identifier State #7
Other Provider Identifier Issuer 7 REGENCE BLUE SHIELD PULLMAN
Other Provider Identifier Issuer #7
Other Provider Identifier 8 00010174293
Other Provider Identifier #8
Other Provider Identifier Type 8 OTHER
Other Provider Identifier Type #8
Other Provider Identifier Issuer 8 FEDERAL BLUE CROSS
Other Provider Identifier Issuer #8
Other Provider Identifier 9 0252321
Other Provider Identifier #9
Other Provider Identifier Type 9 OTHER
Other Provider Identifier Type #9
Other Provider Identifier State 9 WA
Other Provider Identifier State #9
Other Provider Identifier Issuer 9 CRIME VICTIMS COMPENSATION ACT
Other Provider Identifier Issuer #9
Other Provider Identifier 10 1245496744
Other Provider Identifier #10
Other Provider Identifier Type 10 OTHER
Other Provider Identifier Type #10
Other Provider Identifier State 10 ID
Other Provider Identifier State #10
Other Provider Identifier Issuer 10 BLUE CROSS OF IDAHO
Other Provider Identifier Issuer #10
Other Provider Identifier 11 2031565 GRP
Other Provider Identifier #11
Other Provider Identifier Type 11 MEDICAID
Other Provider Identifier Type #11
Other Provider Identifier State 11 WA
Other Provider Identifier State #11
Other Provider Identifier 12 1022RA
Other Provider Identifier #12
Other Provider Identifier Type 12 OTHER
Other Provider Identifier Type #12
Other Provider Identifier Issuer 12 ASURIS
Other Provider Identifier Issuer #12
Other Provider Identifier 13 808565801 PULL
Other Provider Identifier #13
Other Provider Identifier Type 13 MEDICAID
Other Provider Identifier Type #13
Other Provider Identifier State 13 ID
Other Provider Identifier State #13
Other Provider Identifier 14 808565800 CLK
Other Provider Identifier #14
Other Provider Identifier Type 14 MEDICAID
Other Provider Identifier Type #14
Other Provider Identifier State 14 ID
Other Provider Identifier State #14
Other Provider Identifier 15 1245496744
Other Provider Identifier #15
Other Provider Identifier Type 15 OTHER
Other Provider Identifier Type #15
Other Provider Identifier State 15 WA
Other Provider Identifier State #15
Other Provider Identifier Issuer 15 PREMERA BLUE CROSS
Other Provider Identifier Issuer #15

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