=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942419593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL WASHINGTON EYE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 S MAIN ST
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-3685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-925-7611
-----------------------------------------------------
Fax | 509-962-9135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 S MAIN ST
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-3685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-925-7611
-----------------------------------------------------
Fax | 509-962-9135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CHRISTY M SNYDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-925-7611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OD00003882
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------