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NPI Code Detail

MEDICARE: THE HOUR GLASS L.L.C.

MEDICARE: THE HOUR GLASS L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician602959975WA

General Provider Information

NPI Number : 1396067765
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE HOUR GLASS L.L.C.
Provider Business Mailing Address
First Line : 2707 W BROADWAY AVE
Second Line : SUITE A
City : MOSES LAKE
State : WA
Zip : 98837-2931
Country : US
Telephone Number : 509-855-7560
Fax Number : 509-855-7561
Provider Business Practice Location Address
First Line : 2707 W BROADWAY AVE
Second Line : SUITE A
City : MOSES LAKE
State : WA
Zip : 98837-2931
Country : US
Telephone Number : 509-855-7560
Fax Number : 509-855-7561
Authorized Official
Title or Position : OWNER
Name : MR. GEORGE RAMOS
Credential :
Telephone Number : 509-350-6106
Provider Enumeration Date : 02/25/2010
Last Update Date : 02/25/2010

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Directions to “THE HOUR GLASS L.L.C. ” Practice Location

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