| |
950 E Jewett Blvd, White Salmon, WA 98672-1120 | |
(509) 493-2020 | |
(509) 493-2023 |
Full Name | |
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Type | Facility |
Speciality | Eyewear Supplier |
Location | 950 E Jewett Blvd, White Salmon, Washington |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1952821654 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OD60398390 (Washington) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Provider Name | Alex Wagner Baldwin |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1003125188 PECOS PAC ID: 1254562937 Enrollment ID: I20150302002533 |
Mailing Address | Practice Location Address |
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Po Box 1789, White Salmon, WA 98672-1789 Ph: (509) 493-2020 | 950 E Jewett Blvd, White Salmon, WA 98672-1120 Ph: (509) 493-2020 |