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NPI Code Detail

MEDICARE: EYE CLINIC OF BELLEVUE LTD PS

MEDICARE: EYE CLINIC OF BELLEVUE LTD PS
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
1332H00000XEyewear Supplier600047406WA

General Provider Information

NPI Number : 1245357862
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE CLINIC OF BELLEVUE LTD PS
Provider Business Mailing Address
First Line : 1300 116TH AVE NE
Second Line :
City : BELLEVUE
State : WA
Zip : 98004-3808
Country : US
Telephone Number : 425-455-1031
Fax Number :
Provider Business Practice Location Address
First Line : 3236 78TH AVE SE STE 102
Second Line :
City : MERCER ISLAND
State : WA
Zip : 98040-3500
Country : US
Telephone Number : 206-232-0322
Fax Number : 206-232-4751
Authorized Official
Title or Position : MANAGER
Name : KARIN POLZIN
Credential :
Telephone Number : 425-454-3133
Provider Enumeration Date : 03/26/2007
Last Update Date : 06/19/2008

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Directions to “EYE CLINIC OF BELLEVUE LTD PS ” Practice Location

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