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NPI Code Detail

MEDICARE: PRESTON SULLIVAN MD

MEDICARE: PRESTON SULLIVAN MD
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
1207W00000XOphthalmology PhysicianMD00044121WA

Other Identifiers

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

General Provider Information

NPI Number : 1275696056
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRESTON SULLIVAN MD
Provider Business Mailing Address
First Line : 5201 OLYMPIC DR STE 110
Second Line :
City : GIG HARBOR
State : WA
Zip : 98335-1778
Country : US
Telephone Number : 253-432-3238
Fax Number : 253-509-0217
Provider Business Practice Location Address
First Line : 5201 OLYMPIC DR STE 110
Second Line :
City : GIG HARBOR
State : WA
Zip : 98335-1778
Country : US
Telephone Number : 253-432-3238
Fax Number : 253-509-0217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 02/04/2021

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Directions to “ PRESTON SULLIVAN MD” Practice Location

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