MEDICARE: SEATTLE VISION CLINIC INC

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

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	0025778	OTHER	WA	DEPT OF LABOR & INDUSTRIE

General Provider Information

NPI Number	:	1518955202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE VISION CLINIC INC

Provider Business Mailing Address
First Line	:	677 S JACKSON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2928
Country	:	US
Telephone Number	:	206-623-1100
Fax Number	:	206-624-0463

Provider Business Practice Location Address
First Line	:	677 S JACKSON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2928
Country	:	US
Telephone Number	:	206-623-1100
Fax Number	:	206-624-0463

Authorized Official
Title or Position	:	MANAGER
Name	:	EVA W CHAN
Credential	:
Telephone Number	:	206-623-1100

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/16/2010

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Directions to “SEATTLE VISION CLINIC INC ” Practice Location

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