Provider Demographics
NPI:1740412105
Name:BRITTAIN EYE CARE, PS
Entity Type:Organization
Organization Name:BRITTAIN EYE CARE, PS
Other - Org Name:WESTSIDE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-694-0760
Mailing Address - Street 1:7017 NE HIGHWAY 99
Mailing Address - Street 2:STE. 202
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0555
Mailing Address - Country:US
Mailing Address - Phone:360-694-0760
Mailing Address - Fax:360-694-1091
Practice Address - Street 1:7017 NE HIGHWAY 99
Practice Address - Street 2:STE. 202
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0555
Practice Address - Country:US
Practice Address - Phone:360-694-0760
Practice Address - Fax:360-694-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005122Medicaid
WAG8883967Medicare PIN
WA6461770001Medicare NSC
WAB85355Medicare UPIN