Healthcare Provider Details

I. General information

NPI: 1730187899
Provider Name (Legal Business Name): SPOKANE EYE CLINIC INC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S BERNARD ST
SPOKANE WA
99204-2509
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-0107
  • Fax: 509-747-2635
Mailing address:
  • Phone: 908-458-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MADREPERLA
Title or Position: OWNER
Credential: MD, PHD
Phone: 903-458-8333