Provider Demographics
NPI:1023299856
Name:EYES FOR LIFE PS
Entity type:Organization
Organization Name:EYES FOR LIFE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-448-7300
Mailing Address - Street 1:3022 E 57TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7033
Mailing Address - Country:US
Mailing Address - Phone:509-448-7300
Mailing Address - Fax:509-448-7382
Practice Address - Street 1:3022 E 57TH AVE STE 11
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7033
Practice Address - Country:US
Practice Address - Phone:509-448-7300
Practice Address - Fax:509-448-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029569Medicaid
WA2029569Medicaid
WAG8851257Medicare PIN
WADC9335Medicare Oscar/Certification
WA5569900001Medicare NSC