Provider Demographics
NPI:1538483797
Name:YAKIMA EYE CARE, INC., P.S.
Entity Type:Organization
Organization Name:YAKIMA EYE CARE, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-966-2020
Mailing Address - Street 1:506 N 40TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4330
Mailing Address - Country:US
Mailing Address - Phone:509-966-2020
Mailing Address - Fax:509-966-3066
Practice Address - Street 1:506 N 40TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4330
Practice Address - Country:US
Practice Address - Phone:509-966-2020
Practice Address - Fax:509-966-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00008697207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7059611Medicaid
WA7059611Medicaid