Provider Demographics
NPI:1629385232
Name:EPHRATA EYE CARE, PLLC
Entity Type:Organization
Organization Name:EPHRATA EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-754-2020
Mailing Address - Street 1:1070 BASIN ST SW STE F
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1005
Mailing Address - Country:US
Mailing Address - Phone:509-754-2020
Mailing Address - Fax:509-754-9243
Practice Address - Street 1:1070 BASIN ST SW STE F
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1005
Practice Address - Country:US
Practice Address - Phone:509-754-2020
Practice Address - Fax:509-754-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0681290001OtherMEDICARE DME
WA2030252Medicaid
WA0681290001OtherMEDICARE DME
WAU20867Medicare UPIN