Healthcare Provider Details

I. General information

NPI: 1033734835
Provider Name (Legal Business Name): SAO VISION P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 09/06/2023
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13399 NEWCASTLE COMMONS DR
NEWCASTLE WA
98059-3290
US

IV. Provider business mailing address

13399 NEWCASTLE COMMONS DR
NEWCASTLE WA
98059-3290
US

V. Phone/Fax

Practice location:
  • Phone: 408-768-8752
  • Fax:
Mailing address:
  • Phone: 408-768-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MIKIO ODA
Title or Position: CO-OWNER
Credential: OD
Phone: 408-768-8752