Provider Demographics
NPI:1669427043
Name:VANCOUVER EYE CARE PS
Entity type:Organization
Organization Name:VANCOUVER EYE CARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-823-2012
Mailing Address - Street 1:PO BOX 61896
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666
Mailing Address - Country:US
Mailing Address - Phone:360-696-2081
Mailing Address - Fax:360-823-2260
Practice Address - Street 1:17720 SE MILL PLAIN
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-823-2018
Practice Address - Fax:360-823-2022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANCOUVER EYE CARE PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical