Provider Demographics
NPI:1225121163
Name:POWELL, RAYMOND A (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:POWELL
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 1:815 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3307
Mailing Address - Country:US
Mailing Address - Phone:360-757-7070
Mailing Address - Fax:360-757-2903
Practice Address - Street 1:815 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3307
Practice Address - Country:US
Practice Address - Phone:360-757-7070
Practice Address - Fax:360-757-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20318OtherREGENCE BLUESHIELD
WA2014868Medicaid
WA49099OtherDEPT OF LABOR & INDUSTRY
WA2014868Medicaid
WA1053520001Medicare NSC