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General NPI Number Information
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NPI Number | 1538498886
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Entity Type | Organization
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Legal Business Name | SILVERDALE EYE MDS PS
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 9399 RIDGETOP BLVD NW SUITE A
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City | SILVERDALE
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State | WA
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Zip | 98383-9370
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Country | US
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Telephone | 360-337-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 9399 RIDGETOP BLVD NW SUITE A
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City | SILVERDALE
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State | WA
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Zip | 98383-9370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER GLEN RICO
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Credential | M.D.
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Telephone | 360-337-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00026496
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License Number State | WA
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