Provider Demographics
NPI:1629086160
Name:DUGGAN, DOUGLAS C (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:DUGGAN
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 1:6022 THYNEWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6076
Mailing Address - Country:US
Mailing Address - Phone:509-985-6149
Mailing Address - Fax:509-698-3738
Practice Address - Street 1:2926 COVEY LN
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-8941
Practice Address - Country:US
Practice Address - Phone:509-836-2818
Practice Address - Fax:509-836-2235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 3836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2037816Medicaid
WAU 97423Medicare UPIN
WA2037816Medicaid