Provider Demographics
NPI:1366402703
Name:NORTHWEST EYECARE & LASER CENTER, P.S
Entity type:Organization
Organization Name:NORTHWEST EYECARE & LASER CENTER, P.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-927-0700
Mailing Address - Street 1:12120 E MISSION AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5378
Mailing Address - Country:US
Mailing Address - Phone:509-927-0700
Mailing Address - Fax:509-927-7537
Practice Address - Street 1:12120 E MISSION AVE
Practice Address - Street 2:STE 2
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5378
Practice Address - Country:US
Practice Address - Phone:509-927-0700
Practice Address - Fax:509-927-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000300618Medicare ID - Type Unspecified