=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699880245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN W. FERGUSON O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 E MILL PLAIN BLVD
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-418-6001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2006 50TH ST
-----------------------------------------------------
City | WASHOUGAL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98671-9768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-835-5867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | WA OD00000999
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------