Provider Demographics
NPI:1568719128
Name:JESSE MCCARRELL O.D., PS
Entity Type:Organization
Organization Name:JESSE MCCARRELL O.D., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:QUINTON
Authorized Official - Last Name:MCCARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-710-2943
Mailing Address - Street 1:3219 E 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4202
Mailing Address - Country:US
Mailing Address - Phone:509-710-2943
Mailing Address - Fax:
Practice Address - Street 1:3219 E 36TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4202
Practice Address - Country:US
Practice Address - Phone:509-710-2943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60294007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty