Provider Demographics
NPI:1467552430
Name:VAN ORMAN, ERIC ALLAN (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALLAN
Last Name:VAN ORMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 E HIGHWAY 101
Mailing Address - Street 2:VISION CENTER @ WAL-MART
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9148
Mailing Address - Country:US
Mailing Address - Phone:360-452-6131
Mailing Address - Fax:360-452-7950
Practice Address - Street 1:3500 E HIGHWAY 101
Practice Address - Street 2:VISION CENTER @ WAL-MART
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9148
Practice Address - Country:US
Practice Address - Phone:360-452-6131
Practice Address - Fax:360-452-7950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021947Medicaid
WAABO5334Medicare ID - Type UnspecifiedPROVIDER NUMBER
WAU09492Medicare UPIN