Healthcare Provider Details

I. General information

NPI: 1902071392
Provider Name (Legal Business Name): EYE CONSULTANTS, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 N NEVADA ST STE B
SPOKANE WA
99218-1298
US

IV. Provider business mailing address

9911 N NEVADA ST STE B
SPOKANE WA
99218-1298
US

V. Phone/Fax

Practice location:
  • Phone: 509-484-5710
  • Fax: 509-487-1000
Mailing address:
  • Phone: 509-484-5710
  • Fax: 509-487-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberMD00049255
License Number StateWA

VIII. Authorized Official

Name: GARY LEE FILLMORE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 509-484-5710