Provider Demographics
NPI:1770754251
Name:CLEARVUE VISION CENTER, PLLC
Entity type:Organization
Organization Name:CLEARVUE VISION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEITMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-251-9200
Mailing Address - Street 1:8009 S 180TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1042
Mailing Address - Country:US
Mailing Address - Phone:425-251-9200
Mailing Address - Fax:425-251-9201
Practice Address - Street 1:8009 S 180TH ST STE 104
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1042
Practice Address - Country:US
Practice Address - Phone:425-251-9200
Practice Address - Fax:425-251-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8871715Medicare PIN