Provider Demographics
NPI:1851328801
Name:RANA, DUANE L (OD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:L
Last Name:RANA
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 54
Mailing Address - Street 2:
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133-0054
Mailing Address - Country:US
Mailing Address - Phone:509-633-0340
Mailing Address - Fax:509-633-0161
Practice Address - Street 1:407 BURDIN BLVD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-0054
Practice Address - Country:US
Practice Address - Phone:509-633-0340
Practice Address - Fax:509-633-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031508Medicaid
WA1C G000301293Medicare PIN
WAT02379Medicare UPIN
WA0656960001Medicare NSC