Provider Demographics
NPI:1053509562
Name:NORTHWEST VISION CENTER, P.C.
Entity Type:Organization
Organization Name:NORTHWEST VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-489-0493
Mailing Address - Street 1:1510 COOPER POINT RD SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5734
Mailing Address - Country:US
Mailing Address - Phone:360-489-0493
Mailing Address - Fax:360-943-9424
Practice Address - Street 1:1510 COOPER POINT RD SW
Practice Address - Street 2:SUITE 110
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5734
Practice Address - Country:US
Practice Address - Phone:360-489-0493
Practice Address - Fax:360-943-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001152261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8877535Medicare PIN