Provider Demographics
NPI:1831165331
Name:SPOKANE EYE CLINIC INC, PS
Entity type:Organization
Organization Name:SPOKANE EYE CLINIC INC, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-456-0107
Mailing Address - Street 1:427 S BERNARD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-8150
Mailing Address - Fax:509-455-9887
Practice Address - Street 1:427 S BERNARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-8150
Practice Address - Fax:509-455-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600012071261QS0132X
WAASF.FS.60101697261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
490003446OtherRAILROAD MEDICARE
WA191562100OtherL&I
WA7086879Medicaid
AB02449Medicare ID - Type Unspecified