Healthcare Provider Details

I. General information

NPI: 1861034423
Provider Name (Legal Business Name): TRI-CITY EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 KEENE RD
RICHLAND WA
99352-7726
US

IV. Provider business mailing address

203 FALLEY ST
RICHLAND WA
99352-4456
US

V. Phone/Fax

Practice location:
  • Phone: 509-402-2399
  • Fax: 509-260-8895
Mailing address:
  • Phone: 509-627-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON T HAIR
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 509-402-2399