Healthcare Provider Details

I. General information

NPI: 1225044951
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 KIMBALL DR
GIG HARBOR WA
98335-1228
US

IV. Provider business mailing address

6401 KIMBALL DR
GIG HARBOR WA
98335-1228
US

V. Phone/Fax

Practice location:
  • Phone: 253-502-5965
  • Fax: 253-593-8410
Mailing address:
  • Phone: 253-502-5965
  • Fax: 253-593-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFF ROBERTSON
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 253-779-6101