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General NPI Number Information
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NPI Number | 1275726739
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Entity Type | Organization
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Legal Business Name | PROLIANCE SURGEONS, INC., P.S.
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 17130 AVONDALE WAY NE STE 111
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City | REDMOND
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State | WA
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Zip | 98052-4455
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Country | US
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Telephone | 425-885-6600
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Fax | 425-885-6580
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Provider Business Mailing Address
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Address Line | 17130 AVONDALE WAY NE STE 111
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City | REDMOND
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State | WA
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Zip | 98052-4455
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Country | US
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Telephone | 425-885-6600
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Fax | 425-885-6580
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Authorized Official
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Title or Position | CREDENTIALING & ENROLLMENT MANAGER
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Name | CORI M. PLEASANT
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Credential |
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Telephone | 206-838-2585
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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