Provider Demographics
NPI:1265653638
Name:PHYSICIANS OPTICAL
Entity Type:Organization
Organization Name:PHYSICIANS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:509-248-2700
Mailing Address - Street 1:1109 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3209
Mailing Address - Country:US
Mailing Address - Phone:509-248-2700
Mailing Address - Fax:509-248-2702
Practice Address - Street 1:1109 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3209
Practice Address - Country:US
Practice Address - Phone:509-248-2700
Practice Address - Fax:509-248-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2704906OtherDSHS
WA4516210001Medicare ID - Type Unspecified