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General NPI Number Information
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NPI Number | 1982934634
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Entity Type | Organization
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Legal Business Name | MYOPTICS, LLC
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Dates
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Enumeration Date | 12/31/2009
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 1701 S COMMONS
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6037
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Country | US
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Telephone | 253-529-8314
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Fax | 253-941-4980
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Provider Business Mailing Address
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Address Line | 1215 DEXTER AVENUE N. APT. 835
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City | SEATTLE
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State | WA
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Zip | 98109
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Country | US
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Telephone | 832-260-6468
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALICE PHUONG NGUYEN
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Credential | OD
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Telephone | 832-260-6468
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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 | 60063073
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License Number State | WA
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