Provider Demographics
NPI:1558378422
Name:ABC OPTOMETRIC SERVICES INC
Entity Type:Organization
Organization Name:ABC OPTOMETRIC SERVICES INC
Other - Org Name:CLEARWATER FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BADOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-737-2020
Mailing Address - Street 1:6515 WEST CLEARWATER AVE
Mailing Address - Street 2:STE 340
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-737-2020
Mailing Address - Fax:509-737-1036
Practice Address - Street 1:6515 WEST CLEARWATER AVE
Practice Address - Street 2:STE 340
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-737-2020
Practice Address - Fax:509-737-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3336TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020758Medicaid
WA2020758Medicaid
P00321042Medicare PIN
WAG8855932Medicare PIN
WA5473970001Medicare NSC