Provider Demographics
NPI:1992995112
Name:PANORAMA VISION CARE, INC
Entity type:Organization
Organization Name:PANORAMA VISION CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-885-9800
Mailing Address - Street 1:519 NW WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-7545
Mailing Address - Country:US
Mailing Address - Phone:360-885-9800
Mailing Address - Fax:360-885-7989
Practice Address - Street 1:221B NE 104TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4505
Practice Address - Country:US
Practice Address - Phone:360-885-9800
Practice Address - Fax:360-885-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024354Medicaid
WAU39803Medicare UPIN
WAG8858876Medicare PIN