Provider Demographics
NPI:1972610236
Name:JAMES, DONALD K (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:K
Last Name:JAMES
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 1:3330 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4405
Practice Address - Country:US
Practice Address - Phone:208-746-2025
Practice Address - Fax:208-746-0413
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003022152W00000X
MTOPT-OPT-LIC-367152W00000X
IDODP-864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410044997OtherRAIL ROAD MEDICARE
WAG8892821OtherMEDICARE WA
MT011003386OtherMEDICARE MT
WAG8881305OtherMEDICARE WA
ID15923071OtherMEDICARE ID
MT410047408OtherRAIL ROAD MEDICARE
ID410020050OtherRAIL ROAD MEDICARE
WAG8903366OtherMEDICARE WA
WA410044998OtherRAIL ROAD MEDICARE
WA410044999OtherRAIL ROAD MEDICARE
WAG8964651OtherMEDICARE WA
T10329Medicare UPIN
WAGAB27117Medicare PIN
ID1592307Medicare PIN