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General NPI Number Information
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NPI Number | 1740558642
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Entity Type | Organization
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Legal Business Name | CLEAR SIGHT NORTHWEST, PS
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 10700 SE 208TH ST SUITE 205
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City | KENT
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State | WA
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Zip | 98031-5545
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Country | US
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Telephone | 253-852-2120
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Fax | 253-373-0201
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Provider Business Mailing Address
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Address Line | 10700 SE 208TH ST SUITE 205
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City | KENT
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State | WA
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Zip | 98031-5545
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Country | US
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Telephone | 253-852-2120
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Fax | 253-373-0201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KURT J HOFELDT
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Credential | O.D.
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Telephone | 636-359-2159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OD60102590
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD60102590
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License Number State | WA
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