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General NPI Number Information
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NPI Number | 1750585972
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Entity Type | Organization
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Legal Business Name | MID COLUMBIA EYECARE CENTER, INC, PS
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 4403 W COURT ST STE J
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City | PASCO
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State | WA
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Zip | 99301-2879
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Country | US
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Telephone | 509-547-9695
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Fax | 509-547-5017
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Provider Business Mailing Address
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Address Line | 4403 W COURT ST STE J
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City | PASCO
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State | WA
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Zip | 99301-2879
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Country | US
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Telephone | 509-547-9695
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Fax | 509-547-5017
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROMELIA SIFUENTEZ
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Credential |
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Telephone | 509-547-9695
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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 |
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License Number State |
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