Provider Demographics
NPI:1982919015
Name:EYECARE ASSOCIATES OF WEST RICHLAND, LLP
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF WEST RICHLAND, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-967-1503
Mailing Address - Street 1:473 S 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5166
Mailing Address - Country:US
Mailing Address - Phone:509-967-1503
Mailing Address - Fax:509-967-1768
Practice Address - Street 1:473 S 38TH AVE
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5166
Practice Address - Country:US
Practice Address - Phone:509-967-1503
Practice Address - Fax:509-967-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU95912Medicare UPIN
WA8801650Medicare PIN
WA8801648Medicare PIN
WAG8898840Medicare PIN
WAG8863784Medicare PIN