Healthcare Provider Details

I. General information

NPI: 1629189915
Provider Name (Legal Business Name): COAL CREEK FAMILY VISION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 COAL CREEK PKWY SE SUITE B6
NEWCASTLE WA
98059-3136
US

IV. Provider business mailing address

6973 COAL CREEK PKWY SE SUITE B6
NEWCASTLE WA
98059-3136
US

V. Phone/Fax

Practice location:
  • Phone: 425-641-2500
  • Fax: 425-865-9353
Mailing address:
  • Phone: 425-641-2500
  • Fax: 425-865-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003985
License Number StateWA

VIII. Authorized Official

Name: DR. EUGENE CHARLES BALOGH
Title or Position: SOLE MEMBER
Credential: O.D.
Phone: 425-641-2500