Provider Demographics
NPI:1962446948
Name:DUVALL, BRIAN SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:DUVALL
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 1:126 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9175
Mailing Address - Country:US
Mailing Address - Phone:425-831-2020
Mailing Address - Fax:425-831-0027
Practice Address - Street 1:126 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-9175
Practice Address - Country:US
Practice Address - Phone:425-831-2020
Practice Address - Fax:425-831-0027
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025252Medicaid
WAGAB28136Medicare PIN
WA410047573Medicare PIN
WAGAB28134Medicare PIN
WAU85256Medicare UPIN