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General NPI Number Information
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NPI Number | 1134292915
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Entity Type | Organization
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Legal Business Name | 20/20 EYECARE CENTERS INC PS
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 17609 VASHON HWY SW
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City | VASHON
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State | WA
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Zip | 98070-5204
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Country | US
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Telephone | 206-463-2020
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Fax | 206-463-2049
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Provider Business Mailing Address
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Address Line | PO BOX 706
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City | VASHON
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State | WA
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Zip | 98070-5204
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Country | US
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Telephone | 206-463-2020
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Fax | 206-463-2043
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Authorized Official
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Title or Position | OWNER
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Name | JON M WILLEMS
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Credential | OD
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Telephone | 206-463-2020
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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 |
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License Number State |
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