Provider Demographics
NPI:1811647605
Name:NORTHEASTERN WASHINGTON EYECARE
Entity type:Organization
Organization Name:NORTHEASTERN WASHINGTON EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-844-1343
Mailing Address - Street 1:102 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2846
Mailing Address - Country:US
Mailing Address - Phone:509-684-5278
Mailing Address - Fax:509-684-3268
Practice Address - Street 1:102 S OAK ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2846
Practice Address - Country:US
Practice Address - Phone:509-684-5278
Practice Address - Fax:509-684-3268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEASTERN WASHINGTON EYECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty