Provider Demographics
NPI:1043482011
Name:VANCOUVER EYE CARE, P.S.
Entity type:Organization
Organization Name:VANCOUVER EYE CARE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-823-2012
Mailing Address - Street 1:PO BOX 61896
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1896
Mailing Address - Country:US
Mailing Address - Phone:360-823-2012
Mailing Address - Fax:360-823-2260
Practice Address - Street 1:17720 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7583
Practice Address - Country:US
Practice Address - Phone:360-823-2020
Practice Address - Fax:360-823-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0594300004Medicare NSC