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General NPI Number Information
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NPI Number | 1841558848
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Entity Type | Organization
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Legal Business Name | COMMUNITY EYECARE CENTER LLC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 728 S 320TH ST STE F
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5255
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Country | US
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Telephone | 253-941-3937
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Fax | 253-941-3935
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Provider Business Mailing Address
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Address Line | 728 S 320TH ST STE F
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5255
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Country | US
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Telephone | 253-941-3937
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Fax | 253-941-3935
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY W HOMAN
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Credential | O.D.
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Telephone | 253-941-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OD 00004137
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License Number State | WA
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