Organization
PROFESSIONAL VISION SERVICES, PS
Active
Other names
Pacific Vision
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAROLD L. BIRCUMSHAW OD (PRESIDENT)
(253) 473-3443
Entity
Organization
Contact information
Practice address
4620 PACIFIC AVE, TACOMA, WA 98408-7738
(253) 473-3443
(253) 473-7127
Mailing address
4620 PACIFIC AVE, TACOMA, WA 98408-7738
(253) 473-3443
(253) 473-7127
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
1349
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1203680
DSHS VENDOR
WA
01
—
209-783
OFFICE OF DISABILITY INSURANCE
WA
01
—
482,107-02
L & I WORKERS COMP
WA
01
—
61722
SPECTERA
WA
01
—
BI 0008
REGENCE BLUE SHIELD
—
01
—
G8878811
MEDICARE PTAN
WA
01
—
W912748
CHAMPUS
WA
01
—
WA0179
NBN
—
Enumeration date
11/09/2005
Last updated
04/03/2012
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