Organization
COLVILLE VALLEY EYECARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENTON SCOTT MCDOUGALL OD (OWNER)
(509) 684-2221
Entity
Organization
Contact information
Practice address
298 S MAIN ST, SUITE 301, COLVILLE, WA 99114-2447
(509) 684-2221
(509) 684-6222
Mailing address
298 S MAIN ST, SUITE 301, COLVILLE, WA 99114-2447
(509) 684-2221
(509) 684-6222
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1246
WA
152W00000X
Optometrist
60083989
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043433
—
WA
Enumeration date
08/09/2012
Last updated
08/09/2012
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