Healthcare Provider Details

I. General information

NPI: 1457095358
Provider Name (Legal Business Name): NEAR VISION INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18920 BOTHELL WAY NE STE 203
BOTHELL WA
98011-1981
US

IV. Provider business mailing address

18920 BOTHELL WAY NE STE 203
BOTHELL WA
98011-1981
US

V. Phone/Fax

Practice location:
  • Phone: 425-354-3998
  • Fax: 425-949-4491
Mailing address:
  • Phone: 425-354-3998
  • Fax: 425-949-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ALAN PHILIP PEARSON
Title or Position: EXECUTIVE DIRECTOR
Credential: OD
Phone: 425-269-3169