Healthcare Provider Details

I. General information

NPI: 1184689408
Provider Name (Legal Business Name): EVERGREEN EYE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW LEARY WAY SUITE 300
SEATTLE WA
98107-5136
US

IV. Provider business mailing address

1101 MADISON ST SUITE 600
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-342-6041
  • Fax: 206-781-8693
Mailing address:
  • Phone: 206-215-2004
  • Fax: 206-215-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GARY WHAKUK CHUNG
Title or Position: AUTHORIZED OFFICIAL/PHYSICIAN
Credential: MD
Phone: 206-212-2100