Provider Demographics
NPI:1548474075
Name:OLYMPIA IMAGING CENTER
Entity type:Organization
Organization Name:OLYMPIA IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-491-1494
Mailing Address - Street 1:3425 ENSIGN RD NE
Mailing Address - Street 2:STE320
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5425
Mailing Address - Country:US
Mailing Address - Phone:360-491-1494
Mailing Address - Fax:
Practice Address - Street 1:3425 ENSIGN RD NE
Practice Address - Street 2:STE320
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5425
Practice Address - Country:US
Practice Address - Phone:360-491-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602643261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA07-00029280OtherCITY LICENSE