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General NPI Number Information
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NPI Number | 1073740486
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Entity Type | Organization
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Legal Business Name | TRI-CITIES VISION CENTER
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 2720 S QUILLAN ST VISION CENTER
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City | KENNEWICK
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State | WA
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Zip | 99337-2404
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Country | US
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Telephone | 509-585-8314
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Fax | 509-585-9653
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Provider Business Mailing Address
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Address Line | 2720 S QUILLAN ST VISION CENTER
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City | KENNEWICK
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State | WA
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Zip | 99337-2404
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Country | US
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Telephone | 509-585-8314
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Fax | 509-585-9653
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Authorized Official
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Title or Position | OPTOMETRIST/BUSINESS MANAGER
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Name | DR. NATHAN W OWEN
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Credential | O.D.
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Telephone | 509-585-8314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OD60073002
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License Number State | WA
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