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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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