| Advanced Eyecare Center | |
|
104 S Freya Street Suite 220, White Flag Bldg Spokane WA 99202-4867 | |
| (509) 535-5855 | |
| (509) 535-3916 |
| Full Name | Advanced Eyecare Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 104 S Freya Street, Spokane, Washington |
| Authorized Official Name and Position | Donald Todd Wylie (OWNER) |
| Authorized Official Contact | 5095355855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Eyecare Center 104 S Freya Street Suite 220, White Flag Bldg Spokane WA 99202-4867 Ph: (509) 535-5855 | Advanced Eyecare Center 104 S Freya Street Suite 220, White Flag Bldg Spokane WA 99202-4867 Ph: (509) 535-5855 |
| NPI Number | 1730378308 |
|---|---|
| Provider Enumeration Date | 10/19/2007 |
| Last Update Date | 03/21/2019 |
| Medicare PECOS PAC ID | 5496842395 |
|---|---|
| Medicare Enrollment ID | O20071024000366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730378308 | NPI | - | NPPES |
| GAB20237 | Other | WA | MEDICARE |
| 2024842 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1528TX (Washington) | Primary |
| Provider Name | Donald T Wylie |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1750308243 PECOS PAC ID: 8729986724 Enrollment ID: I20031229000897 |
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