| |
17609 Vashon Hwy Sw, Vashon, WA 98070-5204 | |
(206) 463-2020 | |
(206) 463-2049 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 17609 Vashon Hwy Sw, Vashon, Washington |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134292915 | NPI | - | NPPES |
2024420 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
Provider Name | Jon M Willems |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1821072539 PECOS PAC ID: 4789644261 Enrollment ID: I20041019000417 |
Provider Name | John J Mayes |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1073687562 PECOS PAC ID: 3577744648 Enrollment ID: I20110222001057 |
Provider Name | Anthony R Lopez |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1477820660 PECOS PAC ID: 2466671532 Enrollment ID: I20140923000555 |
Mailing Address | Practice Location Address |
---|---|
Po Box 706, Vashon, WA 98070-5204 Ph: (206) 463-2020 | 17609 Vashon Hwy Sw, Vashon, WA 98070-5204 Ph: (206) 463-2020 |