Provider Demographics
NPI:1841205630
Name:JAMES C WAVRA
Entity Type:Organization
Organization Name:JAMES C WAVRA
Other - Org Name:FRANKLIN PARK VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAVRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-487-0600
Mailing Address - Street 1:12 E ROWAN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1232
Mailing Address - Country:US
Mailing Address - Phone:509-487-0600
Mailing Address - Fax:509-487-6238
Practice Address - Street 1:12 E ROWAN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1232
Practice Address - Country:US
Practice Address - Phone:509-487-0600
Practice Address - Fax:509-487-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023588Medicaid