1457095358 NPI number — NEAR VISION INSTITUTE

Table of content: (NPI 1457095358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457095358 NPI number — NEAR VISION INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEAR VISION INSTITUTE
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:
1457095358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18920 BOTHELL WAY NE STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98011-1981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-354-3998
Provider Business Mailing Address Fax Number:
425-949-4491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18920 BOTHELL WAY NE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011-1981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-354-3998
Provider Business Practice Location Address Fax Number:
425-949-4491
Provider Enumeration Date:
04/26/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
PHILIP
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
425-269-3169

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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