Provider Demographics
NPI:1487631370
Name:EYE CARE TEAM INC
Entity type:Organization
Organization Name:EYE CARE TEAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-747-6581
Mailing Address - Street 1:126 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0252
Mailing Address - Country:US
Mailing Address - Phone:509-747-6581
Mailing Address - Fax:509-747-6354
Practice Address - Street 1:126 N WASHINGTON
Practice Address - Street 2:THE EYE CARE TEAM
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0252
Practice Address - Country:US
Practice Address - Phone:509-747-6581
Practice Address - Fax:509-747-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5124830001Medicare NSC