Provider Demographics
NPI:1871692681
Name:LEWIS COUNTY EYE & VISION, INC., P.S.
Entity type:Organization
Organization Name:LEWIS COUNTY EYE & VISION, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-748-9228
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0169
Mailing Address - Country:US
Mailing Address - Phone:360-748-9228
Mailing Address - Fax:360-748-4617
Practice Address - Street 1:1179 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3427
Practice Address - Country:US
Practice Address - Phone:360-748-9228
Practice Address - Fax:360-748-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0036580OtherL&I
WA2046506Medicaid
WAHE7836OtherREGENCE
WAHE7836OtherREGENCE
WA2046506Medicaid
WA0036580OtherL&I
WA410018636Medicare PIN
WAG115144700Medicare Oscar/Certification