1427482413 NPI number — PRO-OPTIX, LLC

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 1427482413 NPI number — PRO-OPTIX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO-OPTIX, LLC
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:
1427482413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1266 NW MIRAGE LN
Provider Second Line Business Mailing Address:
R102
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-8919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-698-4948
Provider Business Mailing Address Fax Number:
360-698-4948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10315 SILVERDALE WAY NW
Provider Second Line Business Practice Location Address:
UNIT # K-7
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-7670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-698-4948
Provider Business Practice Location Address Fax Number:
360-698-4948
Provider Enumeration Date:
08/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BERKHEIMER
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-698-4948

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  332B00000X , 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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