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General NPI Number Information
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NPI Number | 1750820205
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Entity Type | Organization
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Legal Business Name | THE EYESITE PLLC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 12520 LAKE CITY WAY NE
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City | SEATTLE
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State | WA
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Zip | 98125-4425
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Country | US
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Telephone | 206-906-9944
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Fax |
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Provider Business Mailing Address
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Address Line | 12520 LAKE CITY WAY NE
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City | SEATTLE
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State | WA
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Zip | 98125-4425
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Country | US
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Telephone | 206-906-9944
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SORENA KAUR
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Credential | O.D.
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Telephone | 206-906-9944
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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 | OD00003556
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License Number State | WA
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