Provider Demographics
NPI:1811983299
Name:SISSON, GEORGE T (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:SISSON
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 1:1070 BASIN ST SW
Mailing Address - Street 2:STE F
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1005
Mailing Address - Country:US
Mailing Address - Phone:509-754-6131
Mailing Address - Fax:509-754-9243
Practice Address - Street 1:1070 BASIN ST SW
Practice Address - Street 2:STE F
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1005
Practice Address - Country:US
Practice Address - Phone:509-754-6131
Practice Address - Fax:509-754-9243
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0681290001OtherMEDICARE DME
WA2030252Medicaid
WAGAB02407Medicare PIN
WA0681290001OtherMEDICARE DME