Healthcare Provider Details

I. General information

NPI: 1013052885
Provider Name (Legal Business Name): VALLEY EYE & LASER CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17916 TALBOT ROAD SOUTH
RENTON WA
98055
US

IV. Provider business mailing address

17916 TALBOT ROAD SOUTH
RENTON WA
98055
US

V. Phone/Fax

Practice location:
  • Phone: 425-277-6595
  • Fax: 425-430-9486
Mailing address:
  • Phone: 425-277-6595
  • Fax: 425-430-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number0016846
License Number StateWA

VIII. Authorized Official

Name: PAUL NORMAN JOOS
Title or Position: PRESIDENT
Credential: MD
Phone: 425-255-4250