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General NPI Number Information
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NPI Number | 1144358417
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Entity Type | Organization
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Legal Business Name | EYE CLINIC OF BELLEVUE LTD PS
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 1300 116TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-3820
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Country | US
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Telephone | 425-454-7912
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Fax | 425-454-7034
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Provider Business Mailing Address
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Address Line | 1300 116TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-3820
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Country | US
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Telephone | 425-454-7912
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Fax | 425-454-7034
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENT BASSETT
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Credential | MD
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Telephone | 425-454-7912
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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 | MD00018638
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License Number State | WA
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