MEDICARE: SPOKANE VISION THERAPY, 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	152WV0400X	Vision Therapy Optometrist

General Provider Information

NPI Number	:	1699282079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOKANE VISION THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1120 N PINES RD STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4942
Country	:	US
Telephone Number	:	509-590-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 N PINES RD STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4942
Country	:	US
Telephone Number	:	509-590-0607
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	RIKSON ZOLLINGER
Credential	:	OD
Telephone Number	:	509-590-0607

Provider Enumeration Date	:	01/06/2018
Last Update Date	:	12/07/2018

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