Healthcare Provider Details

I. General information

NPI: 1982814075
Provider Name (Legal Business Name): OPTOMETRIC CENTER OF SEATTLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 21ST AVE
SEATTLE WA
98122-5912
US

IV. Provider business mailing address

124 21ST AVE
SEATTLE WA
98122-5912
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-1100
  • Fax: 206-324-7641
Mailing address:
  • Phone: 206-325-1100
  • Fax: 206-324-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. LINDSEY KEITH SEWELL
Title or Position: DIRECTOR
Credential: O.D.
Phone: 206-325-1100