Healthcare Provider Details

I. General information

NPI: 1629385232
Provider Name (Legal Business Name): EPHRATA EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 BASIN ST SW STE F
EPHRATA WA
98823-1005
US

IV. Provider business mailing address

1070 BASIN ST SW STE F
EPHRATA WA
98823-1005
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-2020
  • Fax: 509-754-9243
Mailing address:
  • Phone: 509-754-2020
  • Fax: 509-754-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1908
License Number StateWA

VIII. Authorized Official

Name: PAMELA CLAYTON
Title or Position: MANAGER
Credential:
Phone: 509-754-2020