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General NPI Number Information
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NPI Number | 1104851690
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Entity Type | Organization
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Legal Business Name | PASCO VISION CLINIC, P.S.
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 2715 W COURT ST
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City | PASCO
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State | WA
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Zip | 99301-3911
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Country | US
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Telephone | 509-547-8409
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Fax | 509-547-3751
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Provider Business Mailing Address
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Address Line | 2715 W COURT ST
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City | PASCO
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State | WA
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Zip | 99301-3911
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Country | US
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Telephone | 509-547-8409
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Fax | 509-547-7875
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES C SULLIVAN
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Credential | O.D.
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Telephone | 509-547-8409
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 38
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License Number State | WA
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