Healthcare Provider Details

I. General information

NPI: 1699282079
Provider Name (Legal Business Name): SPOKANE VISION THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N PINES RD STE C
SPOKANE VALLEY WA
99206-4942
US

IV. Provider business mailing address

1120 N PINES RD STE C
SPOKANE VALLEY WA
99206-4942
US

V. Phone/Fax

Practice location:
  • Phone: 509-590-0607
  • Fax:
Mailing address:
  • Phone: 509-590-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: RIKSON ZOLLINGER
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 509-590-0607