Provider Demographics
NPI:1952446585
Name:ROLLING HILLS EYECARE, LLC
Entity Type:Organization
Organization Name:ROLLING HILLS EYECARE, LLC
Other - Org Name:ROLLING HILLS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-397-3961
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1801
Mailing Address - Country:US
Mailing Address - Phone:509-397-3961
Mailing Address - Fax:509-397-6131
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1801
Practice Address - Country:US
Practice Address - Phone:509-397-3961
Practice Address - Fax:509-397-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ9432Medicare PIN
WA4136270002Medicare NSC
WAGAB26665Medicare PIN