Provider Demographics
NPI:1891713541
Name:EYECARE NORTHWEST INC PS
Entity Type:Organization
Organization Name:EYECARE NORTHWEST INC PS
Other - Org Name:VALLEY 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:PO BOX 486
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4101
Mailing Address - Country:US
Mailing Address - Phone:360-336-5734
Mailing Address - Fax:360-336-2825
Practice Address - Street 1:1203 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4101
Practice Address - Country:US
Practice Address - Phone:360-336-5734
Practice Address - Fax:360-336-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02905Medicare UPIN
5394600001Medicare NSC
WAG8864174Medicare PIN