Healthcare Provider Details

I. General information

NPI: 1730399049
Provider Name (Legal Business Name): NORTHWEST PEDIATRIC EYE CARE P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14645 BEL RED RD STE E102
BELLEVUE WA
98007-3929
US

IV. Provider business mailing address

14645 BEL RED RD SUITE E102
BELLEVUE WA
98007-3929
US

V. Phone/Fax

Practice location:
  • Phone: 425-732-6056
  • Fax: 425-732-6059
Mailing address:
  • Phone: 425-732-6056
  • Fax: 425-732-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOD00001609
License Number StateWA

VIII. Authorized Official

Name: KAREN PRESTON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 425-732-6056