1841378056 NPI number — FULL SPECTRUM EYE CARE, P.S.

Table of content: (NPI 1841378056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841378056 NPI number — FULL SPECTRUM EYE CARE, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULL SPECTRUM EYE CARE, P.S.
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:
THE COLUMBIA RIVER 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:
1841378056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 BRADLEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-943-2240
Provider Business Mailing Address Fax Number:
509-943-1575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 BRADLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-943-2240
Provider Business Practice Location Address Fax Number:
509-943-1575
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
DEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-943-2240

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  600570062 , 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: 0166993 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 26278 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1518940 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7115223 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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