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General NPI Number Information
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NPI Number | 1902985682
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Entity Type | Organization
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Legal Business Name | VISION EXPRESS LLC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1045 S 320TH ST
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5300
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Country | US
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Telephone | 253-941-0071
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Fax | 253-941-1885
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Provider Business Mailing Address
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Address Line | 1045 S 320TH ST
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5300
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Country | US
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Telephone | 253-941-0071
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Fax | 253-941-1885
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. BRUCE R WALLACE
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Credential | OD
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Telephone | 253-941-0071
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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 | WA
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