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825 Se Bishop Blvd, Ste 110, Pullman, WA 99163-5517 | |
| (509) 334-1661 | |
| (509) 334-1788 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 825 Se Bishop Blvd, Pullman, Washington |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780708552 | NPI | - | NPPES |
| QMXPR0064819 | Other | WA | MOLINA HEALTHCARE |
| 805350600 | Medicaid | ID | |
| 85977 | Other | ID | BLUE CROSS OF IDAHO |
| BYHB9 | Other | ID | BLUE CROSS OF IDAHO |
| CN6339 | Other | RAILROAD MEDICARE | |
| 7088859 | Medicaid | WA | |
| 8927759 | Other | WA | CRIME VICTIMS COMPENSATION ACT |
| 000010006387 | Other | FEDERAL BLUE CROSS | |
| 000010006385 | Other | ID | REGENCE BLUE SHIELD OF IDAHO |
| 1375873 | Other | ID | IDAHO MEDICARE |
| 0123143 | Other | WA | LABOR & INDUSTRY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
500 Port Dr, Clarkston, WA 99403-1835 Ph: (509) 758-8811 | 825 Se Bishop Blvd, Ste 110, Pullman, WA 99163-5517 Ph: (509) 334-1661 |