Provider Demographics
NPI:1447421722
Name:EBERHARDT VISION CENTER INC.
Entity Type:Organization
Organization Name:EBERHARDT VISION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EBERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-424-0553
Mailing Address - Street 1:1427 N LAVENTURE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2765
Mailing Address - Country:US
Mailing Address - Phone:360-424-0553
Mailing Address - Fax:360-424-9603
Practice Address - Street 1:1427 N LAVENTURE RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2765
Practice Address - Country:US
Practice Address - Phone:360-424-0553
Practice Address - Fax:360-424-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00032379Medicare PIN