Provider Demographics
NPI:1306844154
Name:MAIER, MITCHELL JV (OD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JV
Last Name:MAIER
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 1:427 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-0107
Mailing Address - Fax:509-747-2635
Practice Address - Street 1:427 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-0107
Practice Address - Fax:509-747-2635
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0169290OtherLABOR AND INDUSTRIES
WA2250MAOtherASURIS(REGENCE NW HEALTH)
ID00010143187OtherASURIS(REGENCE BS OF ID)
WA28150OtherGROUP HEALTH
WAA029OtherTRICARE
WAP00010999OtherRAILROAD MEDICARE
WAWA0690OtherNORTHWEST BENEFIT NETWORK
WA2029445Medicaid
WA2250MAOtherASURIS(REGENCE NW HEALTH)
ID00010143187OtherASURIS(REGENCE BS OF ID)