MEDICARE: CASCADE FAMILY EYE CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2085	WA
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053349613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE FAMILY EYE CARE, PLLC

Provider Business Mailing Address
First Line	:	9623 32ND ST SE STE D121
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-5780
Country	:	US
Telephone Number	:	425-377-9747
Fax Number	:	425-377-8757

Provider Business Practice Location Address
First Line	:	9623 32ND ST SE STE D121
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-5780
Country	:	US
Telephone Number	:	425-377-9747
Fax Number	:	425-377-8757

Authorized Official
Title or Position	:	OWNER
Name	:	RODERICK BLAIR BEAZER
Credential	:	OD
Telephone Number	:	801-623-1390

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/28/2020

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