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General NPI Number Information
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NPI Number | 1245496744
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Entity Type | Individual
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Provider Name | DORIAN MAX RAMMELL O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 500 PORT DR
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City | CLARKSTON
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State | WA
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Zip | 99403-1835
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Country | US
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Telephone | 509-758-8811
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Fax | 509-751-1188
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Provider Business Mailing Address
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Address Line | 500 PORT DR
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City | CLARKSTON
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State | WA
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Zip | 99403-1835
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Country | US
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Telephone | 509-758-8811
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Fax | 509-751-1188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3114-035
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD 60108608
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License Number State | WA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 0252321
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | LABOR & INDUSTRY
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Identifier #2
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Identifier Code | 2035350 PIN
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Identifier Type | MEDICAID
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Identifier State | WA
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Identifier Issuer |
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Identifier #3
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Identifier Code | 808328900 GRP
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Identifier Type | MEDICAID
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Identifier State | ID
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Identifier Issuer |
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Identifier #4
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Identifier Code | P00775620
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | RAILROAD MEDICARE
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Identifier #5
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Identifier Code | OD 60108608
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | STATE LICENSE
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Identifier #6
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Identifier Code | 000010174293
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Identifier Type | OTHER
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Identifier State | ID
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Identifier Issuer | REGENCE BLUE SHIELD CLARKSTON
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Identifier #7
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Identifier Code | 000010174294
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Identifier Type | OTHER
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Identifier State | ID
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Identifier Issuer | REGENCE BLUE SHIELD PULLMAN
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Identifier #8
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Identifier Code | 00010174293
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | FEDERAL BLUE CROSS
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Identifier #9
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Identifier Code | 0252321
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | CRIME VICTIMS COMPENSATION ACT
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Identifier #10
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Identifier Code | 1245496744
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Identifier Type | OTHER
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Identifier State | ID
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Identifier Issuer | BLUE CROSS OF IDAHO
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Identifier #11
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Identifier Code | 2031565 GRP
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Identifier Type | MEDICAID
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Identifier State | WA
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Identifier Issuer |
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Identifier #12
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Identifier Code | 1022RA
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | ASURIS
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Identifier #13
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Identifier Code | 808565801 PULL
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Identifier Type | MEDICAID
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Identifier State | ID
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Identifier Issuer |
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Identifier #14
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Identifier Code | 808565800 CLK
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Identifier Type | MEDICAID
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Identifier State | ID
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Identifier Issuer |
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Identifier #15
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Identifier Code | 1245496744
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | PREMERA BLUE CROSS
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=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
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Identifier Code | 000010174293
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Identifier Type | OTHER
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Identifier State | ID
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Identifier Issuer | REGENCE BLUE SHIELD CLARKSTON
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Identifier #2
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Identifier Code | 000010174294
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Identifier Type | OTHER
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Identifier State | ID
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Identifier Issuer | REGENCE BLUE SHIELD PULLMAN
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Identifier #3
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Identifier Code | 00010174293
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | FEDERAL BLUE CROSS
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Identifier #4
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Identifier Code | 0252321
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Identifier Type | OTHER
-----------------------------------------------------
Identifier State | WA
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Identifier Issuer | CRIME VICTIMS COMPENSATION ACT
-----------------------------------------------------
Identifier #5
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Identifier Code | 0252321
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Identifier Type | OTHER
-----------------------------------------------------
Identifier State | WA
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Identifier Issuer | LABOR & INDUSTRY
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Identifier #6
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Identifier Code | 1022RA
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Identifier Type | OTHER
-----------------------------------------------------
Identifier State |
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Identifier Issuer | ASURIS
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Identifier #7
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Identifier Code | 1245496744
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Identifier Type | OTHER
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Identifier State | ID
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Identifier Issuer | BLUE CROSS OF IDAHO
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Identifier #8
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Identifier Code | 1245496744
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | PREMERA BLUE CROSS
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Identifier #9
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Identifier Code | 2031565 GRP
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Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | WA
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Identifier Issuer |
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Identifier #10
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Identifier Code | 2035350 PIN
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Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | WA
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Identifier Issuer |
-----------------------------------------------------
Identifier #11
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Identifier Code | 808328900 GRP
-----------------------------------------------------
Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | ID
-----------------------------------------------------
Identifier Issuer |
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Identifier #12
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Identifier Code | 808565800 CLK
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Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | ID
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Identifier Issuer |
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Identifier #13
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Identifier Code | 808565801 PULL
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Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | ID
-----------------------------------------------------
Identifier Issuer |
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Identifier #14
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Identifier Code | OD 60108608
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Identifier Type | OTHER
-----------------------------------------------------
Identifier State | WA
-----------------------------------------------------
Identifier Issuer | STATE LICENSE
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Identifier #15
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Identifier Code | P00775620
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Identifier Type | OTHER
-----------------------------------------------------
Identifier State | WA
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Identifier Issuer | RAILROAD MEDICARE
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