Healthcare Provider Details

I. General information

NPI: 1295729010
Provider Name (Legal Business Name): ADRIAN EOIN OMALLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 LEVIN RD NW #203
SILVERDALE WA
98383-7849
US

IV. Provider business mailing address

22232 17TH AVE SE STE 308
BOTHELL WA
98021-7425
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-0300
  • Fax: 360-307-0302
Mailing address:
  • Phone: 425-296-3837
  • Fax: 206-215-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD60140589
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD60140589
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: