Organization
PEACEHEALTH
Active
Other names
PEACEHEALTH MEDICAL GROUP-OPTICAL SHOP VANCOUVER NETWORK
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG WATSON (CFO)
(360) 729-1718
Entity
Organization
Contact information
Practice address
505 NE 87TH AVE STE 100, VANCOUVER, WA 98664-4801
(360) 904-6781
(360) 859-3173
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1412
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7140890
—
WA
Enumeration date
05/05/2015
Last updated
04/27/2023
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