Provider Demographics
NPI:1568448843
Name:OPTOMETRY OFFICES PS
Entity Type:Organization
Organization Name:OPTOMETRY OFFICES PS
Other - Org Name:ERIC S HUSSEY OD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-326-2707
Mailing Address - Street 1:PO BOX 28104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-8104
Mailing Address - Country:US
Mailing Address - Phone:509-467-4884
Mailing Address - Fax:509-326-0426
Practice Address - Street 1:25 W NORA AVE
Practice Address - Street 2:#101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4844
Practice Address - Country:US
Practice Address - Phone:509-326-2707
Practice Address - Fax:509-326-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2075208Medicaid
WA2075208Medicaid