1831165331 NPI number — SPOKANE EYE CLINIC INC, PS

Table of content: (NPI 1831165331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831165331 NPI number — SPOKANE EYE CLINIC INC, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPOKANE EYE CLINIC INC, 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:
SPOKANE EYE SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1831165331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 S BERNARD ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-456-8150
Provider Business Mailing Address Fax Number:
509-455-9887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 S BERNARD ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-8150
Provider Business Practice Location Address Fax Number:
509-455-9887
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEPPER
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
509-456-0107

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASF.FS.60101697 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QS0132X , with the licence number: 600012071 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 490003446 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 191562100 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7086879 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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