Healthcare Provider Details

I. General information

NPI: 1831165331
Provider Name (Legal Business Name): SPOKANE EYE CLINIC INC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S BERNARD ST SUITE 200
SPOKANE WA
99204-2509
US

IV. Provider business mailing address

427 S BERNARD ST SUITE 200
SPOKANE WA
99204-2509
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-8150
  • Fax: 509-455-9887
Mailing address:
  • Phone: 509-456-8150
  • Fax: 509-455-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number600012071
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF.FS.60101697
License Number StateWA

VIII. Authorized Official

Name: MONICA SUE NEPPER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 509-456-0107