Healthcare Provider Details

I. General information

NPI: 1619287240
Provider Name (Legal Business Name): DR. STEPHEN NEVETT AND ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2010
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NE NORTHGATE WAY SPC 1101
SEATTLE WA
98125-8538
US

IV. Provider business mailing address

401 NE NORTHGATE WAY SUITE 530
SEATTLE WA
98125-6036
US

V. Phone/Fax

Practice location:
  • Phone: 972-740-2027
  • Fax:
Mailing address:
  • Phone: 972-740-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOD60060955
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STEPHEN DENNIS NEVETT
Title or Position: PRESIDENT
Credential: O.D.
Phone: 972-740-2027