Provider Demographics
NPI:1154657955
Name:TWIN RIVER VISION, INC.
Entity Type:Organization
Organization Name:TWIN RIVER VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-758-9470
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:306 5TH STREET
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-0375
Mailing Address - Country:US
Mailing Address - Phone:509-758-9470
Mailing Address - Fax:509-758-9478
Practice Address - Street 1:306 5TH STREET
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403
Practice Address - Country:US
Practice Address - Phone:509-758-9470
Practice Address - Fax:509-758-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60110615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty