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General NPI Number Information
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NPI Number | 1184191603
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Entity Type | Organization
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Legal Business Name | PACIFIC RETINA CENTER PLLC
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 1412 SW 43RD ST
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 910-742-7427
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Fax |
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Provider Business Mailing Address
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Address Line | 12024 NE 100TH PL
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City | KIRKLAND
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State | WA
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Zip | 98033-8828
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Country | US
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Telephone | 910-742-7427
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAMISON R RIDGELEY
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Credential | MD
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Telephone | 910-742-7427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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