Healthcare Provider Details

I. General information

NPI: 1861237364
Provider Name (Legal Business Name): EVERGREEN EYE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW LEARY WAY STE 300
SEATTLE WA
98107-5138
US

IV. Provider business mailing address

1101 MADISON ST STE 300
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-3550
  • Fax: 206-342-6166
Mailing address:
  • Phone: 206-784-3550
  • Fax: 206-342-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY WHAKUK CHUNG
Title or Position: MANAGER
Credential:
Phone: 206-212-2100