Healthcare Provider Details

I. General information

NPI: 1154337996
Provider Name (Legal Business Name): SIGHTCONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 THIRD AVE NE SUITE 100
SEATTLE WA
98115
US

IV. Provider business mailing address

9709 THIRD AVE NE SUITE 100
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-5556
  • Fax: 206-525-0422
Mailing address:
  • Phone: 206-525-5556
  • Fax: 206-525-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOD00003043
License Number StateWA

VIII. Authorized Official

Name: MILES OTOUPAL
Title or Position: BOARD CHAIRMAN
Credential:
Phone: 206-525-5556