1326194978 NPI number — OLYMPIC OPTICAL, INC., P.S.

Table of content: (NPI 1326194978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326194978 NPI number — OLYMPIC OPTICAL, INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIC OPTICAL, INC., P.S.
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:
1326194978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUILCENE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98376-0849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-301-4553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382-3270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-683-1590
Provider Business Practice Location Address Fax Number:
360-683-7958
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
360-301-4553

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  OD00001715 , 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: 7905458 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: WA0751 . This is a "NORTHWEST BENEFIT NETWORK" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2020469 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007880 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6010488 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00096244 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com