Provider Demographics
NPI:1528237203
Name:YAKIMA VISION CENTER, PC
Entity type:Organization
Organization Name:YAKIMA VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LAIBLE
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-965-5200
Mailing Address - Street 1:2010 W LINCOLN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2413
Mailing Address - Country:US
Mailing Address - Phone:509-965-5200
Mailing Address - Fax:509-452-7563
Practice Address - Street 1:2010 W LINCOLN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2413
Practice Address - Country:US
Practice Address - Phone:509-965-5200
Practice Address - Fax:509-452-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003018261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034494Medicaid
WAG8872148OtherMEDICARE PTAN
WAG8872148OtherMEDICARE PTAN