Healthcare Provider Details

I. General information

NPI: 1104851690
Provider Name (Legal Business Name): PASCO VISION CLINIC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 W COURT ST
PASCO WA
99301-3911
US

IV. Provider business mailing address

2715 W COURT ST
PASCO WA
99301-3911
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-8409
  • Fax: 509-547-3751
Mailing address:
  • Phone: 509-547-8409
  • Fax: 509-547-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number38
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES C SULLIVAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 509-547-8409