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General NPI Number Information
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NPI Number | 1699817346
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Entity Type | Organization
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Legal Business Name | CASCADE EYE & SKIN CENTERS PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 1703 S MERIDIAN STE 201
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City | PUYALLUP
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State | WA
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Zip | 98371-7590
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Country | US
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Telephone | 253-848-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 S MERIDIAN SUITE 101
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City | PUYALLUP
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State | WA
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Zip | 98371-7590
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Country | US
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Telephone | 253-770-7708
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Fax | 253-770-7630
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Authorized Official
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Title or Position | BUSINESS OPERATIONS MANAGER
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Name | NICOLE JELMBERG-BRAYTON
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Credential |
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Telephone | 253-446-3904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 601325507
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License Number State | WA
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