Provider Demographics
NPI:1801948013
Name:OPTIC ONE EYE CARE CENTERS OF SPOKANE PC
Entity type:Organization
Organization Name:OPTIC ONE EYE CARE CENTERS OF SPOKANE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-328-2632
Mailing Address - Street 1:513 E HASTINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1977
Mailing Address - Country:US
Mailing Address - Phone:509-328-2632
Mailing Address - Fax:
Practice Address - Street 1:513 E HASTINGS RD STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1977
Practice Address - Country:US
Practice Address - Phone:509-328-2632
Practice Address - Fax:509-324-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022473Medicaid
WA0179414OtherDEPT OF LABOR & IND
WADC4871OtherPALMETTO RR MEDICARE
WA0179414OtherDEPT OF LABOR & IND