1306045497 NPI number — LOWER VALLEY EYE CARE INC.

Table of content: (NPI 1306045497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306045497 NPI number — LOWER VALLEY EYE CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWER VALLEY EYE CARE 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:
1306045497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 S 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98944-1570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-837-3005
Provider Business Mailing Address Fax Number:
509-837-3174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-3005
Provider Business Practice Location Address Fax Number:
509-837-3174
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEPEW
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-837-3005

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1355TX , 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: 5385690001 . This is a "DMERC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2029155 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com