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General NPI Number Information
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NPI Number | 1699158261
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Entity Type | Organization
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Legal Business Name | COLUMBIA CREST EYE CARE
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 7301 W DESCHUTES AVE STE B
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City | KENNEWICK
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State | WA
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Zip | 99336-7799
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Country | US
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Telephone | 509-735-2020
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Fax | 509-783-2135
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Provider Business Mailing Address
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Address Line | 7301 W DESCHUTES AVE STE B
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City | KENNEWICK
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State | WA
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Zip | 99336-7799
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Country | US
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Telephone | 509-735-2020
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Fax | 509-783-2135
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SSALLY MURPHY
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Credential | OFFICE MANAGER
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Telephone | 509-735-2020
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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 | OD60483368
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003112
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00001355
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License Number State | WA
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