1992825426 NPI number — OPTICAL ELEGANCE,INC

Table of content: (NPI 1992825426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992825426 NPI number — OPTICAL ELEGANCE,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICAL ELEGANCE,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992825426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 E ROWAN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99207-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-482-2020
Provider Business Mailing Address Fax Number:
509-482-2012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 E ROWAN AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-2020
Provider Business Practice Location Address Fax Number:
509-482-2012
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWEATT
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-482-2020

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0506570001 . This is a "STERLING OPTION ONE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 108163 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: OP1983 . This is a "ASURIS NW HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: WA10 . This is a "LIFEWISE OF WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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