Provider Demographics
NPI:1508058645
Name:UPTOWN VISION CENTER INC PS
Entity Type:Organization
Organization Name:UPTOWN VISION CENTER INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-943-3119
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0728
Mailing Address - Country:US
Mailing Address - Phone:509-943-3119
Mailing Address - Fax:
Practice Address - Street 1:1335 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3401
Practice Address - Country:US
Practice Address - Phone:509-943-3119
Practice Address - Fax:509-946-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1438TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG319208100Medicare PIN
WADN0207Medicare PIN
WA0264830001Medicare NSC