Healthcare Provider Details

I. General information

NPI: 1417123472
Provider Name (Legal Business Name): AHRENS VALLEY EYEWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E MAIN ST
MONROE WA
98272-1505
US

IV. Provider business mailing address

121 E MAIN ST
MONROE WA
98272-1505
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-5941
  • Fax: 360-200-5278
Mailing address:
  • Phone: 360-794-5941
  • Fax: 360-200-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RICHARD S AHRENS
Title or Position: OWNER/OPTICIAN
Credential: L.D.O.
Phone: 360-794-5941