Provider Demographics
NPI:1780859942
Name:EYECARE NORTHWEST INC PS
Entity Type:Organization
Organization Name:EYECARE NORTHWEST INC PS
Other - Org Name:STANWOOD VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-336-5734
Mailing Address - Street 1:1203 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4101
Mailing Address - Country:US
Mailing Address - Phone:360-770-4798
Mailing Address - Fax:
Practice Address - Street 1:9730 SR 532 STE D
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8054
Practice Address - Country:US
Practice Address - Phone:360-336-5734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5394600002Medicare NSC
WAG8864175Medicare PIN
WAT02905Medicare UPIN