Healthcare Provider Details

I. General information

NPI: 1003467705
Provider Name (Legal Business Name): DIONE SCHUBACH, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SE 1ST ST
WINLOCK WA
98596
US

IV. Provider business mailing address

3613 SE 181ST AVE
VANCOUVER WA
98683-8265
US

V. Phone/Fax

Practice location:
  • Phone: 360-785-3861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIONE SCHUBACH
Title or Position: PRESIDENT
Credential: OD
Phone: 503-473-4025