Provider Demographics
NPI:1760664841
Name:TWIN HARBORS EYE CENTER PS
Entity Type:Organization
Organization Name:TWIN HARBORS EYE CENTER PS
Other - Org Name:TWIN HARBORS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-533-2020
Mailing Address - Street 1:207 S CHEHALIS ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2945
Mailing Address - Country:US
Mailing Address - Phone:360-533-2020
Mailing Address - Fax:360-533-1978
Practice Address - Street 1:207 S CHEHALIS ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2945
Practice Address - Country:US
Practice Address - Phone:360-533-2020
Practice Address - Fax:360-533-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1246640001OtherPROVIDER/CLINIC#
WA1246640001OtherPROVIDER/CLINIC#