Provider Demographics
NPI:1043366610
Name:KINTNER, JAMES E (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:KINTNER
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 1:3700 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2636
Mailing Address - Country:US
Mailing Address - Phone:509-735-1312
Mailing Address - Fax:506-736-6403
Practice Address - Street 1:3700 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-735-1312
Practice Address - Fax:506-736-6403
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022150Medicaid
WAG8874682Medicare UPIN
WA410048598Medicare PIN
WA2022150Medicaid