Provider Demographics
NPI:1881719516
Name:WORLEY, JAMES D JR (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:WORLEY
Suffix:JR
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 371
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-0371
Mailing Address - Country:US
Mailing Address - Phone:509-877-4292
Mailing Address - Fax:509-877-4292
Practice Address - Street 1:215 S WAPATO AVE
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-1344
Practice Address - Country:US
Practice Address - Phone:509-877-4292
Practice Address - Fax:509-877-4292
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2106102Medicaid
WA2106102Medicaid
WAG000119409Medicare ID - Type Unspecified