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General NPI Number Information
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NPI Number | 1982883302
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Entity Type | Organization
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Legal Business Name | EAGLE EYE VISION CARE PS
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 17320 135TH AVE NE STE D
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City | WOODINVILLE
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State | WA
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Zip | 98072-8565
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Country | US
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Telephone | 425-398-1862
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Fax |
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Provider Business Mailing Address
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Address Line | 17320 135TH AVE NE STE D
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City | WOODINVILLE
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State | WA
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Zip | 98072-8565
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Country | US
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Telephone | 425-398-1862
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KERRI W. SCARBROUGH
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Credential | O.D.
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Telephone | 425-398-1862
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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 | WA1675TX
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License Number State | WA
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