Provider Demographics
NPI:1285804617
Name:PRECISION EYE CARE PS
Entity type:Organization
Organization Name:PRECISION EYE CARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-254-5855
Mailing Address - Street 1:8400 NE VANCOUVER MALL LOOP
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6648
Mailing Address - Country:US
Mailing Address - Phone:360-254-5855
Mailing Address - Fax:360-885-0661
Practice Address - Street 1:8400 NE VANCOUVER MALL LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6648
Practice Address - Country:US
Practice Address - Phone:360-254-5855
Practice Address - Fax:360-885-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601840864305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU34023Medicare UPIN
WA0788540001Medicare NSC
WAGAB33422Medicare PIN