MEDICARE: PACIFIC EYECARE & OPTICAL, PLLC

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	261QH0100X	Health Service Clinic/Center	OD3853	WA

General Provider Information

NPI Number	:	1205168184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC EYECARE & OPTICAL, PLLC

Provider Business Mailing Address
First Line	:	5208 E WHITEHALL LN
Second Line	:
City	:	COLBERT
State	:	WA
Zip	:	99005-9165
Country	:	US
Telephone Number	:	509-844-8184
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 W LOWELL AVE
Second Line	:	SUITE 120
City	:	SPOKANE
State	:	WA
Zip	:	99208-8587
Country	:	US
Telephone Number	:	509-868-0215
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. THOMAS A MYERS
Credential	:	OD
Telephone Number	:	509-844-8184

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	08/02/2019

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