Healthcare Provider Details

I. General information

NPI: 1841641396
Provider Name (Legal Business Name): BUENA VISTA EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E CHESTNUT AVE
YAKIMA WA
98901-2174
US

IV. Provider business mailing address

1600 E CHESTNUT AVE
YAKIMA WA
98901-2174
US

V. Phone/Fax

Practice location:
  • Phone: 509-576-3989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD 60277653
License Number StateWA

VIII. Authorized Official

Name: ROYCE K BARNEY
Title or Position: OWNER
Credential: OD
Phone: 509-528-2024