1194095752 NPI number — WASHINGTON EYE CARE PLLC

Table of content: (NPI 1194095752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194095752 NPI number — WASHINGTON EYE CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON EYE CARE 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:
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:
1194095752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12600 SE 38TH ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98006-6105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12600 SE 38TH ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-6105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-298-5005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
BENSON
Authorized Official Middle Name:
Authorized Official Title or Position:
OPHTHALMOLOGIST
Authorized Official Telephone Number:
206-498-8000

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD00047239 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2016663 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306906722 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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