Organization
SELAH VISION SOURCE, PLLC
Active
Other names
Selah Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY S GRAF (PROJECTS MANAGER)
(509) 697-6177
Entity
Organization
Contact information
Practice address
105 W ORCHARD AVE, SELAH, WA 98942-1329
(509) 697-6177
(509) 697-6659
Mailing address
105 W ORCHARD AVE, SELAH, WA 98942-1329
(509) 697-6177
(509) 697-6659
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2610001320
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17129
L & I
WA
05
—
2051902
—
WA
01
—
8905978
L & I CRIME VICTIMS
WA
01
—
C 600 340 4768
UBI #
WA
Enumeration date
03/14/2007
Last updated
02/26/2008
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