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General NPI Number Information
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NPI Number | 1306045497
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Entity Type | Organization
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Legal Business Name | LOWER VALLEY EYE CARE INC.
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 326 S 9TH ST
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City | SUNNYSIDE
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State | WA
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Zip | 98944-1570
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Country | US
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Telephone | 509-837-3005
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Fax | 509-837-3174
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Provider Business Mailing Address
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Address Line | 326 S 9TH ST
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City | SUNNYSIDE
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State | WA
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Zip | 98944-1570
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Country | US
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Telephone | 509-837-3005
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Fax | 509-837-3174
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Authorized Official
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Title or Position | OWNER
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Name | MR. KENNETH C DEPEW
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Credential | OD
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Telephone | 509-837-3005
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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 | 1355TX
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License Number State | WA
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