Healthcare Provider Details

I. General information

NPI: 1568932630
Provider Name (Legal Business Name): WASHINGTON PHYSICIANS EYECARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 NE HIGHWAY 99
VANCOUVER WA
98665-8858
US

IV. Provider business mailing address

3801 S CONGRESS AVE
PALM SPRINGS FL
33461-4140
US

V. Phone/Fax

Practice location:
  • Phone: 360-326-0005
  • Fax: 360-326-0064
Mailing address:
  • Phone: 561-275-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ALISHA JACKSON
Title or Position: SENIOR REVENUE CYCLE MANAGER
Credential:
Phone: 561-208-1591