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General NPI Number Information
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NPI Number | 1124224217
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Entity Type | Organization
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Legal Business Name | MAPLE VALLEY EYE CARE CENTER PS
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 26615 MAPLE VALLEY BLACK DIAMOND RD SE
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City | MAPLE VALLEY
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State | WA
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Zip | 98038-8347
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Country | US
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Telephone | 425-413-8787
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Fax | 425-413-4012
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Provider Business Mailing Address
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Address Line | 26615 MAPLE VALLEY BLACK DIAMOND RD SE
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City | MAPLE VALLEY
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State | WA
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Zip | 98038-8347
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Country | US
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Telephone | 425-413-8787
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Fax | 425-413-4012
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT KEIL NEAL
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Credential | OD
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Telephone | 425-413-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3489TX
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License Number State | WA
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