Provider Demographics
NPI:1194919613
Name:KENNEWICK VISION CARE PC
Entity type:Organization
Organization Name:KENNEWICK VISION CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-735-1312
Mailing Address - Street 1:3700 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2636
Mailing Address - Country:US
Mailing Address - Phone:509-735-1312
Mailing Address - Fax:509-736-6403
Practice Address - Street 1:3700 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-735-1312
Practice Address - Fax:509-736-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA146425100000OtherPREMERA
WA410049433OtherRAILROAD MEDICARE
WA2004356Medicaid
WA146425100000OtherPREMERA
WA2004356Medicaid
WA5239650001Medicare NSC