Provider Demographics
NPI:1639248354
Name:LOWER COLUMBIA EYE CLINIC INC PS
Entity Type:Organization
Organization Name:LOWER COLUMBIA EYE CLINIC INC PS
Other - Org Name:LOWER COLUMBIA OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HULBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-423-0220
Mailing Address - Street 1:600 TRIANGLE CENTER
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-423-0220
Mailing Address - Fax:360-423-0697
Practice Address - Street 1:600 TRIANGLE CENTER
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-0220
Practice Address - Fax:360-423-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005858Medicaid