Provider Demographics
NPI:1750858577
Name:WASHINGTON EYE CARE CENTER PC
Entity Type:Organization
Organization Name:WASHINGTON EYE CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:NILE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-747-6581
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0836
Mailing Address - Country:US
Mailing Address - Phone:509-935-2020
Mailing Address - Fax:509-935-6795
Practice Address - Street 1:306 N PARK ST
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8971
Practice Address - Country:US
Practice Address - Phone:509-935-2020
Practice Address - Fax:509-935-6795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON EYE CARE CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty