Provider Demographics
NPI:1629638929
Name:NORTHEASTERN WASHINGTON EYECARE
Entity Type:Organization
Organization Name:NORTHEASTERN WASHINGTON EYECARE
Other - Org Name:NEWPORT VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-844-1343
Mailing Address - Street 1:3109 S DEARBORN LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1536
Mailing Address - Country:US
Mailing Address - Phone:509-670-1578
Mailing Address - Fax:
Practice Address - Street 1:205 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9670
Practice Address - Country:US
Practice Address - Phone:509-447-2945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty