Provider Demographics
NPI:1013114743
Name:ADVANCED EYE CARE CENTER, P.S.
Entity Type:Organization
Organization Name:ADVANCED EYE CARE CENTER, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-256-0203
Mailing Address - Street 1:3993 NW CURRAWONG CT
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8521
Mailing Address - Country:US
Mailing Address - Phone:360-256-0203
Mailing Address - Fax:
Practice Address - Street 1:2100 SE 164TH AVE
Practice Address - Street 2:SUITE D104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8934
Practice Address - Country:US
Practice Address - Phone:360-256-0203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022424Medicaid
WA2022424Medicaid