Provider Demographics
NPI:1518953058
Name:EYECARE CENTER LLC
Entity type:Organization
Organization Name:EYECARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN PTR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAULAURIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-455-0001
Mailing Address - Street 1:12310 NE 8TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3185
Mailing Address - Country:US
Mailing Address - Phone:425-455-0001
Mailing Address - Fax:425-462-7387
Practice Address - Street 1:12310 NE 8TH ST
Practice Address - Street 2:STE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3185
Practice Address - Country:US
Practice Address - Phone:425-455-0001
Practice Address - Fax:425-462-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080901Medicaid
WA2080901Medicaid
WAG000105359Medicare PIN