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General NPI Number Information
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NPI Number | 1912410150
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Entity Type | Organization
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Legal Business Name | ISSAQUAH VISION CENTER PLLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 1460 NW GILMAN BLVD STE K2
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City | ISSAQUAH
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State | WA
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Zip | 98027-5300
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Country | US
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Telephone | 425-654-3652
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Fax | 425-654-3638
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Provider Business Mailing Address
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Address Line | 685 17TH AVE NW
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City | ISSAQUAH
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State | WA
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Zip | 98027-5371
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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 | GENERAL MANAGER
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Name | TONY CHIANG
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Credential |
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Telephone | 425-228-3364
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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 |
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License Number State |
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