1710318522 NPI number — DAVID LEFEVRE, OD, PLLC

Table of content: (NPI 1710318522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710318522 NPI number — DAVID LEFEVRE, OD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID LEFEVRE, OD, 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:
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:
1710318522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 WILMINGTON DR
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
DUPONT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98327-8773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-912-0900
Provider Business Mailing Address Fax Number:
253-912-8080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1570 WILMINGTON DR
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327-8773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-912-0900
Provider Business Practice Location Address Fax Number:
253-912-8080
Provider Enumeration Date:
12/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LEFEVRE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
253-912-0900

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  1555 , 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: 1124183264 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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