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General NPI Number Information
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NPI Number | 1235189549
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Entity Type | Organization
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Legal Business Name | PACIFIC VISION & HEARING, PLLC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 3800 BRIDGEPORT WAY W SUITE A358
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4495
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Country | US
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Telephone | 253-347-7339
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 BRIDGEPORT WAY W SUITE A 358
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4495
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Country | US
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Telephone | 253-347-7339
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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. SCOTT L BEASLEY
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Credential | O.D.
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Telephone | 253-347-7339
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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 | 4005
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License Number State | WA
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