Provider Demographics
NPI:1083454334
Name:VISION SOURCE OF WENATCHEE, PS
Entity type:Organization
Organization Name:VISION SOURCE OF WENATCHEE, PS
Other - Org Name:
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 1:131 S APPLE BLOSSOM DR UNIT 114
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8827
Mailing Address - Country:US
Mailing Address - Phone:509-661-6188
Mailing Address - Fax:
Practice Address - Street 1:131 S APPLE BLOSSOM DR UNIT 114
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8827
Practice Address - Country:US
Practice Address - Phone:509-661-6188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty