MEDICARE: WILLIAM PENTECOST, OD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD60017743	WA

General Provider Information

NPI Number	:	1285023713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM PENTECOST, OD, PLLC

Provider Business Mailing Address
First Line	:	1317 E PINE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4021
Country	:	US
Telephone Number	:	206-420-8328
Fax Number	:	206-420-5368

Provider Business Practice Location Address
First Line	:	4854 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1742
Country	:	US
Telephone Number	:	206-619-2084
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM PENTECOST
Credential	:
Telephone Number	:	206-619-2084

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	07/02/2015

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