Provider Demographics
NPI:1164670790
Name:SALMON CREEK VISION CENTRE, PLLC
Entity type:Organization
Organization Name:SALMON CREEK VISION CENTRE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER/OWNER, OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-574-6030
Mailing Address - Street 1:14201 NE 20TH AVE STE A102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6411
Mailing Address - Country:US
Mailing Address - Phone:360-574-6030
Mailing Address - Fax:360-574-4116
Practice Address - Street 1:14201 NE 20TH AVE STE A102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6411
Practice Address - Country:US
Practice Address - Phone:360-574-6030
Practice Address - Fax:360-574-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8876163OtherPTAN
WA6162910001Medicare NSC