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General NPI Number Information
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NPI Number | 1871692681
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Entity Type | Organization
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Legal Business Name | LEWIS COUNTY EYE & VISION, INC., P.S.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 1179 S MARKET BLVD
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City | CHEHALIS
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State | WA
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Zip | 98532-3427
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Country | US
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Telephone | 360-748-9228
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Fax | 360-748-4617
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Provider Business Mailing Address
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Address Line | PO BOX 1126
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City | CHEHALIS
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State | WA
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Zip | 98532-0169
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Country | US
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Telephone | 360-748-9228
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Fax | 360-748-4617
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN C STODDARD
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Credential | O.D.
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Telephone | 360-748-9228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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