1306229760 NPI number — ADVANCED FAMILY EYE CARE OF DUVALL

Table of content: (NPI 1306229760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306229760 NPI number — ADVANCED FAMILY EYE CARE OF DUVALL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED FAMILY EYE CARE OF DUVALL
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:
1306229760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14610 MAIN ST NE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DUVALL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98019-8469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-788-2990
Provider Business Mailing Address Fax Number:
425-276-0538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14610 MAIN ST NE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DUVALL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98019-8469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-788-2990
Provider Business Practice Location Address Fax Number:
425-650-9896
Provider Enumeration Date:
07/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
FIONA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
425-788-2990

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD60351798 , 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)





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