Provider Demographics
NPI:1730399049
Name:NORTHWEST PEDIATRIC EYE CARE P.S.
Entity type:Organization
Organization Name:NORTHWEST PEDIATRIC EYE CARE P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-732-6056
Mailing Address - Street 1:14645 BEL RED RD
Mailing Address - Street 2:SUITE E102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3929
Mailing Address - Country:US
Mailing Address - Phone:425-732-6056
Mailing Address - Fax:425-732-6059
Practice Address - Street 1:14645 BEL RED RD
Practice Address - Street 2:STE E102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3929
Practice Address - Country:US
Practice Address - Phone:425-732-6056
Practice Address - Fax:425-732-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001609152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031482Medicaid
WA2031482Medicaid
WAU87583Medicare UPIN