Provider Demographics
NPI:1881694941
Name:TRAVIS, DONALD A (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:TRAVIS
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 1:7301 W DESCHUTES AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7799
Mailing Address - Country:US
Mailing Address - Phone:509-735-2020
Mailing Address - Fax:509-735-2020
Practice Address - Street 1:7301 W DESCHUTES AVE STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7799
Practice Address - Country:US
Practice Address - Phone:509-735-2020
Practice Address - Fax:509-735-2020
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000003112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0196714OtherLOBOR AND INDUSTRIES
WA2019172Medicaid
WAG8850935Medicare PIN
WA0196714OtherLOBOR AND INDUSTRIES