Provider Demographics
NPI:1508208984
Name:EBERHARDT VISION CENTER, INC
Entity Type:Organization
Organization Name:EBERHARDT VISION CENTER, INC
Other - Org Name:ARLINGTON VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:360-435-2043
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-0020
Mailing Address - Country:US
Mailing Address - Phone:360-435-2043
Mailing Address - Fax:360-435-6014
Practice Address - Street 1:524 N MACLEOD AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1226
Practice Address - Country:US
Practice Address - Phone:360-435-2043
Practice Address - Fax:360-435-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1029366Medicaid