Provider Demographics
NPI:1588771448
Name:POHL, MAYNARD L (OD)
Entity type:Individual
Prefix:DR
First Name:MAYNARD
Middle Name:L
Last Name:POHL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2606 116TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1422
Practice Address - Country:US
Practice Address - Phone:425-462-7664
Practice Address - Fax:425-462-6429
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410017357OtherRAIL ROAD MEDICARE
WA1014085Medicaid
WA410045002OtherRAIL ROAD MEDICARE
WA410028403OtherRAIL ROAD MEDICARE
MT1588771448Medicaid
WAG000686618Medicare PIN
WAG001056808Medicare PIN
WAG000985510Medicare PIN
WA410045002OtherRAIL ROAD MEDICARE
WAG000165103Medicare PIN