Provider Demographics
NPI:1801964069
Name:OGDEN, JAMES REXFORD (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:REXFORD
Last Name:OGDEN
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 250
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620
Mailing Address - Country:US
Mailing Address - Phone:509-773-4114
Mailing Address - Fax:509-773-4293
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620
Practice Address - Country:US
Practice Address - Phone:509-773-4114
Practice Address - Fax:509-773-4293
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD1014152W00000X
WA1014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2649200Medicaid
WAG000615205Medicare PIN
WAT60998Medicare UPIN
WA0196900001Medicare NSC