Provider Demographics
NPI:1841558848
Name:COMMUNITY EYECARE CENTER LLC
Entity Type:Organization
Organization Name:COMMUNITY EYECARE CENTER LLC
Other - Org Name:EYEWEAR GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-941-3937
Mailing Address - Street 1:728 S 320TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5255
Mailing Address - Country:US
Mailing Address - Phone:253-941-3937
Mailing Address - Fax:253-941-3935
Practice Address - Street 1:728 S 320TH ST STE F
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5255
Practice Address - Country:US
Practice Address - Phone:253-941-3937
Practice Address - Fax:253-941-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 00004137261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center