Provider Demographics
NPI:1144358417
Name:EYE CLINIC OF BELLEVUE LTD PS
Entity type:Organization
Organization Name:EYE CLINIC OF BELLEVUE LTD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-454-7912
Mailing Address - Street 1:1300 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3820
Mailing Address - Country:US
Mailing Address - Phone:425-454-7912
Mailing Address - Fax:425-454-7034
Practice Address - Street 1:1300 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3820
Practice Address - Country:US
Practice Address - Phone:425-454-7912
Practice Address - Fax:425-454-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018638207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7716509Medicaid
WA217132900Medicare ID - Type Unspecified
WA0195900001Medicare NSC