MEDICARE: EYES FOR LIFE PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD00003911	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023299856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES FOR LIFE PS

Provider Business Mailing Address
First Line	:	3022 E 57TH AVE STE 11
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-7033
Country	:	US
Telephone Number	:	509-448-7300
Fax Number	:	509-448-7382

Provider Business Practice Location Address
First Line	:	3022 E 57TH AVE STE 11
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-7033
Country	:	US
Telephone Number	:	509-448-7300
Fax Number	:	509-448-7382

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HEAVIN MAIER
Credential	:	O.D.
Telephone Number	:	509-448-7300

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	09/17/2021

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Directions to “EYES FOR LIFE PS ” Practice Location

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