Healthcare Provider Details

I. General information

NPI: 1811445018
Provider Name (Legal Business Name): NORTHWEST GLAUCOMA AND CATARACT CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 1250
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 1250
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-2020
  • Fax: 206-223-1963
Mailing address:
  • Phone: 206-622-2020
  • Fax: 206-223-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF.FS 60685668
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberASF.FS 60685668
License Number StateWA

VIII. Authorized Official

Name: JOHN WHITEHEAD
Title or Position: MEMBER/OWNER
Credential: M.D.
Phone: 206-622-2020