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General NPI Number Information
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NPI Number | 1043586670
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Entity Type | Organization
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Legal Business Name | EYE INSTITUTE OF OLYMPIA INC. P.S.
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 300 LILLY RD NE SUITE C
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City | OLYMPIA
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State | WA
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Zip | 98506-5428
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Country | US
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Telephone | 360-438-2207
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Fax | 360-438-2231
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Provider Business Mailing Address
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Address Line | 300 LILLY RD NE SUITE C
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City | OLYMPIA
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State | WA
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Zip | 98506-5428
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Country | US
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Telephone | 360-438-2207
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Fax | 360-438-2231
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBRA S WEEDON
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Credential |
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Telephone | 360-438-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD00023118
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License Number State | WA
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