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General NPI Number Information
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NPI Number | 1518412063
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Entity Type | Organization
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Legal Business Name | EYEBALLZ LTD.
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 621 5TH AVE N STE B
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City | SEATTLE
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State | WA
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Zip | 98109-4241
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Country | US
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Telephone | 206-217-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 166 ROY ST
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City | SEATTLE
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State | WA
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Zip | 98109-4128
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Country | US
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Telephone | 206-217-2015
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | QUANG NGUYEN
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Credential | OD
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Telephone | 206-217-2015
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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 | 60389090
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License Number State | WA
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