Healthcare Provider Details

I. General information

NPI: 1447464573
Provider Name (Legal Business Name): NORTHWEST WASHINGTON EYE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 WEST MARINE VIEW DRIVE SUITE 130
EVERETT WA
98201-2088
US

IV. Provider business mailing address

1724 WEST MARINE VIEW DRIVE SUITE 130
EVERETT WA
98201-2088
US

V. Phone/Fax

Practice location:
  • Phone: 425-252-2333
  • Fax:
Mailing address:
  • Phone: 425-252-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD000029567
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD00029567
License Number StateWA

VIII. Authorized Official

Name: MR. MICHAEL VENEDICT OSETINSKY
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 425-252-2333