Provider Demographics
NPI:1972559458
Name:CENTRAL WASHINGTON EYE CLINIC PLLC
Entity Type:Organization
Organization Name:CENTRAL WASHINGTON EYE CLINIC PLLC
Other - Org Name:WASHINGTON VALLEY EYE & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-255-4250
Mailing Address - Street 1:3902 CREEKSIDE LOOP
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4876
Mailing Address - Country:US
Mailing Address - Phone:509-452-6611
Mailing Address - Fax:509-248-0621
Practice Address - Street 1:425 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4926
Practice Address - Country:US
Practice Address - Phone:425-255-4250
Practice Address - Fax:425-271-3294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL WASHINGTON EYE CLINIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2021-06-14
Deactivation Date:2021-03-03
Deactivation Code:
Reactivation Date:2021-03-25
Provider Licenses
StateLicense IDTaxonomies
WAMD00038596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE3333OtherREGENCE BLUE SHIELD
WA7114580Medicaid
135530OtherLABOR AND INDUSTRIES
180045644OtherRAILROAD MEDICARE
8933290OtherCRIME VICTIMS
CE3333OtherREGENCE BLUE SHIELD
G86711Medicare UPIN