Healthcare Provider Details

I. General information

NPI: 1407971187
Provider Name (Legal Business Name): 310 VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NW MARKET ST
SEATTLE WA
98107-5225
US

IV. Provider business mailing address

1701 NW MARKET ST
SEATTLE WA
98107-5225
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-0700
  • Fax: 206-706-8822
Mailing address:
  • Phone: 206-784-0700
  • Fax: 206-706-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDOOOOOO749
License Number StateWA

VIII. Authorized Official

Name: MRS. KIMBERLY ANNE MEUCCI
Title or Position: PARTNER
Credential: LDO
Phone: 206-784-0700