Healthcare Provider Details

I. General information

NPI: 1023537008
Provider Name (Legal Business Name): ZILLAH VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 ZILLAH WEST RD
ZILLAH WA
98953-9542
US

IV. Provider business mailing address

PO BOX 294
SELAH WA
98942-0294
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-2777
  • 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: DR. BRETT MOWER
Title or Position: MANAGING MEMBER
Credential: OD
Phone: 509-307-7012