Provider Demographics
NPI:1417712241
Name:FRONTLINE VISION. LLC
Entity Type:Organization
Organization Name:FRONTLINE VISION. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-425-0335
Mailing Address - Street 1:16314 E WHIRLAWAY LN
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8879
Mailing Address - Country:US
Mailing Address - Phone:480-321-6805
Mailing Address - Fax:
Practice Address - Street 1:604 S SULLIVAN RD STE D
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-5129
Practice Address - Country:US
Practice Address - Phone:509-425-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty