Provider Demographics
NPI:1538219787
Name:VISION SOURCE OF WENATCHEE, PS
Entity type:Organization
Organization Name:VISION SOURCE OF WENATCHEE, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DONAGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-662-9671
Mailing Address - Street 1:1133 US HIGHWAY 2
Mailing Address - Street 2:SUITE G
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1439
Mailing Address - Country:US
Mailing Address - Phone:509-548-7379
Mailing Address - Fax:509-548-4524
Practice Address - Street 1:1133 US HIGHWAY 2
Practice Address - Street 2:SUITE G
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1439
Practice Address - Country:US
Practice Address - Phone:509-548-7379
Practice Address - Fax:509-548-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023893Medicaid
WA2023893Medicaid
WA5665620002Medicare NSC