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General NPI Number Information
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NPI Number | 1417156589
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Entity Type | Organization
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Legal Business Name | CORRECTIONAL INDUSTRIES - DOC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 11919 W SPRAGUE AVE
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City | AIRWAY HEIGHTS
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State | WA
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Zip | 99001
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Country | US
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Telephone | 509-244-6748
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Fax | 509-244-6735
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Provider Business Mailing Address
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Address Line | 11919 W SPRAGUE AVE
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City | AIRWAY HEIGHTS
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State | WA
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Zip | 99001-1959
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Country | US
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Telephone | 509-244-6748
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Fax | 509-244-6735
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. JAMES H PARKER
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Credential |
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Telephone | 509-244-6748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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