MEDICARE: WASHINGTON STATE UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WV0400X	Vision Therapy Optometrist
2	207Q00000X	Family Medicine Physician
3	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811726193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	412 E SPOKANE FALLS BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-2131
Country	:	US
Telephone Number	:	509-505-7481
Fax Number	:	509-606-2515

Provider Business Practice Location Address
First Line	:	310 N RIVERPOINT BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-1610
Country	:	US
Telephone Number	:	509-505-7481
Fax Number	:	509-606-2515

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MELISSA BOCARDO
Credential	:
Telephone Number	:	509-505-7481

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	06/01/2026

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Directions to “WASHINGTON STATE UNIVERSITY ” Practice Location

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