Provider Demographics
NPI:1558463208
Name:FAMILY VISION CARE OF YAKIMA PC
Entity Type:Organization
Organization Name:FAMILY VISION CARE OF YAKIMA PC
Other - Org Name:FAMILY VISION CARE PS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-248-5378
Mailing Address - Street 1:3907 CASTLEVALE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7802
Mailing Address - Country:US
Mailing Address - Phone:509-248-5378
Mailing Address - Fax:509-248-5740
Practice Address - Street 1:3907 CASTLEVALE RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7802
Practice Address - Country:US
Practice Address - Phone:509-248-5378
Practice Address - Fax:509-248-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862096Medicare PIN