MEDICARE: AESTHETIC EYE ASSOCIATES AMBULATORY SURGERY CENTER 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	261QS0132X	Ophthalmologic Surgery Clinic/Center		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G8905884	OTHER	WA	PTAN

General Provider Information

NPI Number	:	1689695231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETIC EYE ASSOCIATES AMBULATORY SURGERY CENTER PLLC

Provider Business Mailing Address
First Line	:	625 4TH AVE
Second Line	:	SUITE 302
City	:	KIRKLAND
State	:	WA
Zip	:	98033-9028
Country	:	US
Telephone Number	:	425-216-7200
Fax Number	:	425-216-7272

Provider Business Practice Location Address
First Line	:	625 4TH AVE
Second Line	:	STE 301
City	:	KIRKLAND
State	:	WA
Zip	:	98033-9028
Country	:	US
Telephone Number	:	425-216-7200
Fax Number	:	425-216-7272

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JANET JORDAN
Credential	:
Telephone Number	:	425-216-7200

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	06/19/2013

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