Provider Demographics
NPI:1285675140
Name:SPECTRUM EYE CARE INC PS
Entity Type:Organization
Organization Name:SPECTRUM EYE CARE INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE ANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-682-2708
Mailing Address - Street 1:PO BOX 3142
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-3142
Mailing Address - Country:US
Mailing Address - Phone:509-682-2708
Mailing Address - Fax:509-682-2713
Practice Address - Street 1:126 E JOHNSON
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-3100
Practice Address - Country:US
Practice Address - Phone:509-682-2708
Practice Address - Fax:509-682-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA003674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025179Medicaid
WA4869090001Medicare NSC
WA2025179Medicaid