Organization
INNOVATIONS IN EYECARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH L. DOLEZAL O.D. (PRESIDENT)
(360) 736-7385
Entity
Organization
Contact information
Practice address
1125 MELLEN ST, CENTRALIA, WA 98531-1173
(360) 736-7385
(360) 736-8568
Mailing address
1125 MELLEN ST, CENTRALIA, WA 98531-1173
(360) 736-7385
(360) 736-8568
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1421
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005916
—
WA
01
—
DR4454
RAILROAD MEDICARE PTAN
WA
Enumeration date
01/05/2009
Last updated
08/11/2011
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