Provider Demographics
NPI:1033517149
Name:MOWER VISION SOURCE, PLLC
Entity Type:Organization
Organization Name:MOWER VISION SOURCE, PLLC
Other - Org Name:SELAH VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-307-7012
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-0294
Mailing Address - Country:US
Mailing Address - Phone:509-697-2020
Mailing Address - Fax:509-697-6659
Practice Address - Street 1:1 JIM CLEMENTS WAY
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1437
Practice Address - Country:US
Practice Address - Phone:509-697-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60367942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty