Healthcare Provider Details

I. General information

NPI: 1588717110
Provider Name (Legal Business Name): EDWARD ARTHUR DENZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MAPLE ST
EVERETT WA
98201-3832
US

IV. Provider business mailing address

2930 MAPLE ST
EVERETT WA
98201-3832
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-1500
  • Fax: 425-261-1515
Mailing address:
  • Phone: 425-261-1500
  • Fax: 425-261-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7693T
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD61157592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: