Provider Demographics
NPI:1497415087
Name:DW FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:DW FAMILY EYE CARE PLLC
Other - Org Name:VALLEY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-305-9694
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0783
Mailing Address - Country:US
Mailing Address - Phone:509-689-2342
Mailing Address - Fax:509-689-9207
Practice Address - Street 1:123 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-0015
Practice Address - Country:US
Practice Address - Phone:509-689-2342
Practice Address - Fax:509-689-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty