Healthcare Provider Details

I. General information

NPI: 1871929646
Provider Name (Legal Business Name): NORTHWEST EYELID AND ORBITAL SPECIALISTS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 S SHERIDAN ST
SPOKANE WA
99202-1325
US

IV. Provider business mailing address

626 S. SHERIDAN ST.
SPOKANE WA
99202-1325
US

V. Phone/Fax

Practice location:
  • Phone: 509-279-2176
  • Fax: 509-279-2941
Mailing address:
  • Phone: 509-279-2176
  • Fax: 509-279-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SCOTT MICHELS
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 509-279-2176