1154399319 NPI number — EYE ASSOCIATES NORTHWEST, PLLC

Table of content: (NPI 1154399319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154399319 NPI number — EYE ASSOCIATES NORTHWEST, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE ASSOCIATES NORTHWEST, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EVERGREEN OPTICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154399319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MADISON ST
Provider Second Line Business Mailing Address:
STE 600
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-215-2004
Provider Business Mailing Address Fax Number:
206-215-2055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11325 NE 120TH ST STE 11325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-6907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-775-0548
Provider Business Practice Location Address Fax Number:
425-670-6708
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPOS
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
206-215-2004

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com