Healthcare Provider Details

I. General information

NPI: 1811952815
Provider Name (Legal Business Name): EYE ASSOCIATES NORTHWEST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 600
SEATTLE WA
98104-1340
US

IV. Provider business mailing address

1101 MADISON ST SUITE 600
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2020
  • Fax: 206-215-2022
Mailing address:
  • Phone: 206-215-2020
  • Fax: 206-215-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROSA ANGELICA CAMPOS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 206-215-2004