Provider Demographics
NPI:1144846031
Name:PUGET SOUND VISION CARE PC
Entity type:Organization
Organization Name:PUGET SOUND VISION CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-853-3011
Mailing Address - Street 1:15412 128TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-5038
Mailing Address - Country:US
Mailing Address - Phone:253-358-0281
Mailing Address - Fax:
Practice Address - Street 1:11400 51ST AVE
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7891
Practice Address - Country:US
Practice Address - Phone:253-858-1881
Practice Address - Fax:253-858-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty