Healthcare Provider Details

I. General information

NPI: 1861697070
Provider Name (Legal Business Name): MEDICAL VISION CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W. MAIN ST.
MORTON WA
98356
US

IV. Provider business mailing address

240 W. MAIN ST. P.O. BOX AC
MORTON WA
98356
US

V. Phone/Fax

Practice location:
  • Phone: 360-496-5140
  • Fax: 360-496-6039
Mailing address:
  • Phone: 360-496-5140
  • Fax: 360-496-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00000957
License Number StateWA

VIII. Authorized Official

Name: DR. DONALD A CARROLL
Title or Position: OWNER
Credential: O.D.
Phone: 360-496-5140