Healthcare Provider Details

I. General information

NPI: 1699817346
Provider Name (Legal Business Name): CASCADE EYE & SKIN CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S MERIDIAN STE 201
PUYALLUP WA
98371-7590
US

IV. Provider business mailing address

1703 S MERIDIAN SUITE 101
PUYALLUP WA
98371-7590
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-3000
  • Fax:
Mailing address:
  • Phone: 253-770-7708
  • Fax: 253-770-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number601325507
License Number StateWA

VIII. Authorized Official

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