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General NPI Number Information
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NPI Number | 1407244981
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Entity Type | Organization
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Legal Business Name | EYEWISE OPTOMETRY GROUP, INC.
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 9000 NE HIGHWAY 99
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City | VANCOUVER
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State | WA
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Zip | 98665-8923
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Country | US
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Telephone | 360-571-4095
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Fax | 360-687-0033
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Provider Business Mailing Address
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Address Line | 1201 SW 13TH AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-2800
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Country | US
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Telephone | 360-723-9010
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Fax | 360-687-0033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW PEARCE
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Credential | OD, MPH, FAAO
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Telephone | 360-723-9010
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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 | OD3762
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License Number State | WA
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