Healthcare Provider Details

I. General information

NPI: 1659393635
Provider Name (Legal Business Name): PHYSICIANS EYE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/09/2014
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: 425-259-2020
  • Fax: 425-259-2801
Mailing address:
  • Phone: 425-259-2020
  • Fax: 425-259-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS W JONES JR.
Title or Position: MEMBER
Credential: M.D.
Phone: 425-551-5204