1568448843 NPI number — OPTOMETRY OFFICES PS

Table of content: (NPI 1568448843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568448843 NPI number — OPTOMETRY OFFICES PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTOMETRY OFFICES PS
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:
ERIC S HUSSEY OD
Provider Other Organization Name Type Code:
5
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:
1568448843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99228-8104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-467-4884
Provider Business Mailing Address Fax Number:
509-326-0426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 W NORA AVE
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-2707
Provider Business Practice Location Address Fax Number:
509-326-0426
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSEY
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
SHAW
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
509-326-2707

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1090 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2075208 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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