CHAD RYAN BOUTERSE


Address: 500 Port Dr, Clarkston, WA 99403-1835
Phone: 5097588811

CHAD RYAN BOUTERSE (NPI# 1699896167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1699896167
Entity Type Individual
Full Name CHAD RYAN BOUTERSE
Credential D.O.
Practice Address 500 Port Dr
Clarkston
WA 99403-1835
Practice Telephone 5097588811
Practice Fax Number 5097511188
Mailing Telephone 5097588811
Mailing Fax Number 5097511188
Enumeration Date 2007-04-03
Last Update Date 2010-05-28
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207W00000X Ophthalmology O 570 ID Allopathic & Osteopathic Physicians
Y 207W00000X Ophthalmology OP60127012 WA Allopathic & Osteopathic Physicians
N 207W00000X Ophthalmology 5101016467 MI Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
BLUE CROSS OF IDAHO 1699896167 01
ASURIS - CLARKSTON 0080BO 01
REGENCE BLUE SHIELD 1699896167 01
FEDERAL BLUE CROSS 1699896167 01
PREMERA BLUE CROSS 1699896167 01
ID STATE LICENSE O 0570 01
ID MEDICAID - PULLMAN 808567101 01
WA 8564387 05
WA STATE LICENSE OP60127012 01
ASURIS - PULLMAN 0081BO 01
ID MEDICAID - CLARKSTON 808567100 01
WA WASHINGTON LABOR & INDUSTRY 258958 01

Office Location

Street Address 500 PORT DR
City CLARKSTON
State WA
Zip Code 99403-1835

Providers in the same location

NPI Name Taxonomy Address Enumeration
1821088147 Richard J Eggleston Ophthalmology 500 Port Dr, Clarkston, WA 99403-1835 2005-10-27
1043623309 Julia Lienesch Nurse Anesthetist, Certified Registered 500 Port Dr, Clarkston, WA 99403-1835 2014-06-04
1245496744 Dorian Max Rammell Optometrist 500 Port Dr, Clarkston, WA 99403-1835 2008-08-04
1649361007 Mary L Muench Registered Nurse 500 Port Dr, Clarkston, WA 99403-1835 2006-09-28
1376556514 Eye Care Specialists Ps Ophthalmology 500 Port Dr, Clarkston, WA 99403-1835 2006-08-15
1972514917 Eye Care Specialists Ps Optometrist 500 Port Dr, Clarkston, WA 99403-1835 2006-08-11
1639160450 Eye Care Specialists Ps Optometrist 500 Port Dr, Clarkston, WA 99403-1835 2005-11-01

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1306409669 Jessica Elaine Krull Specialist/Technologist 807 3rd Street, Clarkston, WA 99403 2019-04-22
1477006526 Idaho County Rideshare Non-emergency Medical Transport (VAN) 1470 Elm Street, Clarkston, WA 99403 2016-07-25
1679921340 Jonathan Preszler Counselor 629 6th Street, Educational and Psychological Services, Clarkston, WA 99403 2016-06-02
1104204957 Optimal Health and Wellness Clinic/Center 1267 Belmont Way, Clarkston, WA 99403 2015-05-13
1326456351 David Nygren Pharmacist 506 5th St, Clarkston, WA 99403 2014-07-22
1255672895 Alpowa Healthcare, Inc. Hospice Care, Community Based 1370 Bridge Street, Clarkston, WA 99403 2013-03-06
1265799407 Elizabeth Bagnulo Dacey Pathology 1225 Highland Avenue, Clarkston, WA 99403 2012-04-12
1649586256 Zeeshan Afzal Internal Medicine 1119 Highland Ave Ste 3, Clarkston, WA 99403 2010-08-20
1154657955 Twin River Vision, Inc. Optometrist 306 5th Street, Clarkston, WA 99403 2009-10-29
1649429317 Elizabeth Marie Allen-racicot Specialist 1013 Bridge Street, Clarkston, WA 99403 2008-09-17
Find all providers in zip 99403

Taxonomy Information

Taxonomy Code 207W00000X
Grouping Allopathic & Osteopathic Physicians
Classification Ophthalmology

Taxonomy Definition

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1912385154 Stefanie Denise Sherman Ophthalmology 5825 S Main St Ste 100, Clarkston, MI 48346-2983 2015-05-07
1154358190 Saul M Rubenstein Ophthalmology 6875 Dixie Hwy, Clarkston, MI 48346-2008 2006-06-26
1821088147 Richard J Eggleston Ophthalmology 500 Port Dr, Clarkston, WA 99403-1835 2005-10-27
1306836705 Mark T Eggleston Ophthalmology 500 Port Drive, Clarkston, WA 99403-1835 2005-10-26
1538154125 Arlin H French Ophthalmology 5825 S Main St, Suite 100, Clarkston, MI 48346-2983 2005-09-20
1134460272 Wilkinson Eye Center Ophthalmology 6875 Dixie Hwy, Clarkston, MI 48346-5106 2013-03-14
1922249937 Oakland Eye Care, P.C. Ophthalmology 5701 Bow Pointe Dr, Suite 135, Clarkston, MI 48346-3198 2009-03-20
1760632004 W Richard Herbert Md Ps Ophthalmology 617 Diagonal St, Clarkston, WA 99403-2041 2008-09-23
1245332980 Oakland Eye Care, P.C. Ophthalmology 5825 S Main St, Suite 100, Clarkston, MI 48346-2983 2006-09-02
1083724900 Christopher Naresh Singh Ophthalmology 5885 S Main St, Ste 2, Clarkston, MI 48346-2981 2006-08-30
Find all providers in CLARKSTON

Competitor

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City CLARKSTON
Zip Code 99403

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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