Healthcare Provider Details

I. General information

NPI: 1033204938
Provider Name (Legal Business Name): CASCADE EYE & SKIN CENTERS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S MERIDIAN SUITE 101
PUYALLUP WA
98371
US

IV. Provider business mailing address

1703 S MERIDIAN SUITE 101
PUYALLUP WA
98371
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-3000
  • Fax: 253-840-6514
Mailing address:
  • Phone: 253-848-3000
  • Fax: 253-840-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JELMBERG-BRAYTON
Title or Position: BUSINESS OPERATIONS MANAGER
Credential:
Phone: 253-446-3904