Provider Demographics
NPI:1093796823
Name:EYE AND EAR CLINIC OF WENATCHEE INC PS
Entity Type:Organization
Organization Name:EYE AND EAR CLINIC OF WENATCHEE INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-662-7143
Mailing Address - Street 1:PO BOX 3027
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-3027
Mailing Address - Country:US
Mailing Address - Phone:509-662-7143
Mailing Address - Fax:509-665-4301
Practice Address - Street 1:933 RED APPLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3370
Practice Address - Country:US
Practice Address - Phone:509-662-7143
Practice Address - Fax:509-665-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017010Medicaid
WA2017010Medicaid