Healthcare Provider Details

I. General information

NPI: 1689695231
Provider Name (Legal Business Name): AESTHETIC EYE ASSOCIATES AMBULATORY SURGERY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 4TH AVE STE 301
KIRKLAND WA
98033-9028
US

IV. Provider business mailing address

625 4TH AVE SUITE 302
KIRKLAND WA
98033-9028
US

V. Phone/Fax

Practice location:
  • Phone: 425-216-7200
  • Fax: 425-216-7272
Mailing address:
  • Phone: 425-216-7200
  • Fax: 425-216-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: JANET JORDAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 425-216-7200