Provider Demographics
NPI:1417943556
Name:APPLE VALLEY EYE CENTER, INC
Entity Type:Organization
Organization Name:APPLE VALLEY EYE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:I
Authorized Official - Last Name:LABISSONIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-966-8801
Mailing Address - Street 1:1121 S 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3930
Mailing Address - Country:US
Mailing Address - Phone:509-966-8801
Mailing Address - Fax:509-965-9804
Practice Address - Street 1:1121 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3930
Practice Address - Country:US
Practice Address - Phone:509-966-8801
Practice Address - Fax:509-965-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1006152W00000X
WA3993152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020998Medicaid
WA2020998Medicaid
WA0631620001Medicare NSC
WAAB02452Medicare PIN
WAT0274Medicare UPIN