Provider Demographics
NPI:1770690679
Name:URNESS, JEFFREY R (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:URNESS
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:8200 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1680
Practice Address - Country:US
Practice Address - Phone:509-736-0826
Practice Address - Fax:509-735-6868
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID410043347OtherRAIL ROAD MEDICARE
WA410043341OtherRAIL ROAD MEDICARE
WA410045033OtherRAIL ROAD MEDICARE
WA410022657OtherRAIL ROAD MEDICARE
OR410045034OtherRAIL ROAD MEDICARE
ORR041WFBNKEMedicare PIN
WAG319209220Medicare PIN
WA410022657OtherRAIL ROAD MEDICARE
WAG001056819Medicare PIN
WAG000686623Medicare PIN
WA410045033OtherRAIL ROAD MEDICARE
ID410043347OtherRAIL ROAD MEDICARE
WA410043341OtherRAIL ROAD MEDICARE
WAG000985515Medicare PIN