Provider Demographics
NPI:1770065377
Name:PULLMAN VISION SOURCE
Entity type:Organization
Organization Name:PULLMAN VISION SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEVLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-334-1131
Mailing Address - Street 1:238 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2619
Mailing Address - Country:US
Mailing Address - Phone:509-334-1131
Mailing Address - Fax:509-332-4062
Practice Address - Street 1:238 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2619
Practice Address - Country:US
Practice Address - Phone:509-334-1131
Practice Address - Fax:509-332-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty