1225005697 NPI number — EYE ASSOCIATES NORTHWEST, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225005697 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:
Provider Other Organization Name Type Code:
6
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:
1225005697
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:
206-215-2020
Provider Business Mailing Address Fax Number:
206-386-2047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 MADISON ST
Provider Second Line Business Practice Location Address:
STE 600
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-2020
Provider Business Practice Location Address Fax Number:
206-386-2047
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPOS
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
A
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)





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