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General NPI Number Information
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NPI Number | 1245357862
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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 | 03/26/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 3236 78TH AVE SE STE 102
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3500
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Country | US
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Telephone | 206-232-0322
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Fax | 206-232-4751
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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 | 98004-3808
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Country | US
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Telephone | 425-455-1031
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KARIN POLZIN
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Credential |
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Telephone | 425-454-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 600047406
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License Number State | WA
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