Provider Demographics
NPI:1629337332
Name:VISION ARTS EYECARE CENTER
Entity Type:Organization
Organization Name:VISION ARTS EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-327-7753
Mailing Address - Street 1:205 W INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4763
Mailing Address - Country:US
Mailing Address - Phone:509-327-7753
Mailing Address - Fax:509-328-6057
Practice Address - Street 1:205 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4763
Practice Address - Country:US
Practice Address - Phone:509-327-7753
Practice Address - Fax:509-328-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 00001263332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017259Medicaid
WAU29746Medicare UPIN