Healthcare Provider Details

I. General information

NPI: 1548287303
Provider Name (Legal Business Name): GALLERY OF EYEWEAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 HOYT AVE
EVERETT WA
98201-4919
US

IV. Provider business mailing address

3930 HOYT AVE
EVERETT WA
98201-4919
US

V. Phone/Fax

Practice location:
  • Phone: 425-551-5195
  • Fax: 425-259-2801
Mailing address:
  • Phone: 425-551-5195
  • Fax: 425-259-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD00757
License Number StateWA

VIII. Authorized Official

Name: MRS. LORI M MOSES
Title or Position: BOOKKEEPER
Credential:
Phone: 425-551-5195