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General NPI Number Information
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NPI Number | 1013114743
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Entity Type | Organization
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Legal Business Name | ADVANCED EYE CARE CENTER, P.S.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 2100 SE 164TH AVE SUITE D104
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City | VANCOUVER
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State | WA
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Zip | 98683-8934
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Country | US
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Telephone | 360-256-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 3993 NW CURRAWONG CT
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City | CAMAS
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State | WA
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Zip | 98607-8521
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Country | US
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Telephone | 360-256-0203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY RONALD GARNER
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Credential | O.D.
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Telephone | 360-256-0203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3389
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License Number State | WA
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