Healthcare Provider Details

I. General information

NPI: 1861572034
Provider Name (Legal Business Name): NORTHWEST EYE CLINIC INC., PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 SQUALICUM PARKWAY SUITE 260
BELLINGHAM WA
98225-1945
US

IV. Provider business mailing address

3015 SQUALICUM PARKWAY SUITE 260
BELLINGHAM WA
98225-1945
US

V. Phone/Fax

Practice location:
  • Phone: 360-733-4800
  • Fax: 360-733-2879
Mailing address:
  • Phone: 360-733-4800
  • Fax: 360-733-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VINCENT E. MATTEUCCI
Title or Position: TREASURER
Credential: M.D.
Phone: 360-733-4800