Healthcare Provider Details

I. General information

NPI: 1871692681
Provider Name (Legal Business Name): LEWIS COUNTY EYE & VISION, INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 S MARKET BLVD
CHEHALIS WA
98532-3427
US

IV. Provider business mailing address

PO BOX 1126
CHEHALIS WA
98532-0169
US

V. Phone/Fax

Practice location:
  • Phone: 360-748-9228
  • Fax: 360-748-4617
Mailing address:
  • Phone: 360-748-9228
  • Fax: 360-748-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN C STODDARD
Title or Position: CEO
Credential: O.D.
Phone: 360-748-9228