Healthcare Provider Details

I. General information

NPI: 1619171527
Provider Name (Legal Business Name): STEPHEN G GOO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8032 35TH AVE NE
SEATTLE WA
98115-4815
US

IV. Provider business mailing address

8032 35TH AVE NE
SEATTLE WA
98115-4815
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-6676
  • Fax: 206-523-7900
Mailing address:
  • Phone: 206-523-6676
  • Fax: 206-523-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3262
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: