Healthcare Provider Details

I. General information

NPI: 1649252693
Provider Name (Legal Business Name): EYE AND EAR CLINIC OF WENATCHEE INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 RED APPLE RD SUITE 100
WENATCHEE WA
98801-3370
US

IV. Provider business mailing address

PO BOX 3027
WENATCHEE WA
98807-3027
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-7143
  • Fax: 509-665-4301
Mailing address:
  • Phone: 509-662-7143
  • Fax: 509-665-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MR. ED P TAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-662-7143