Healthcare Provider Details

I. General information

NPI: 1164611133
Provider Name (Legal Business Name): HOQUIAM VISION CLINIC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 7TH ST
HOQUIAM WA
98550-3615
US

IV. Provider business mailing address

403 7TH ST
HOQUIAM WA
98550-3615
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-7395
  • Fax: 360-532-6907
Mailing address:
  • Phone: 360-533-7395
  • Fax: 360-532-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00001404
License Number StateWA

VIII. Authorized Official

Name: DR. EDWARD J WAYMAN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 360-533-7395