Healthcare Provider Details

I. General information

NPI: 1659441160
Provider Name (Legal Business Name): NORTHWEST VISION INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 NE 10TH PL STE 200
BELLEVUE WA
98005-2487
US

IV. Provider business mailing address

12301 NE 10TH PL STE 200
BELLEVUE WA
98005-2487
US

V. Phone/Fax

Practice location:
  • Phone: 425-450-2020
  • Fax: 425-688-0620
Mailing address:
  • Phone: 425-450-2020
  • Fax: 425-688-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00027511
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberBG0163446
License Number StateWA

VIII. Authorized Official

Name: DR. MICHAEL L GILBERT
Title or Position: OWNER SOLE PROPRIETOR
Credential: MD
Phone: 425-450-2020