| Organization Name: | EVERGREEN OPTICAL INC. |
| NPI Number: | 1033502000 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANNE MARIE MILLER (OFFICE MANAGER) |
| Mailing Address: | 351 Orondo Ave Wenatchee |
| State: | WA US |
| Postal Code: | 988012826 |
| Phone Number: | 5096624747 |
| Fax Number: | 5096635338 |
| NPI Enumeration Date: | 03/13/2015 |
| NPI Last Update Date: | 03/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | DO 00000833 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |