Provider Demographics
NPI:1811546286
Name:OCEAN OPTICAL REDMOND PLLC
Entity type:Organization
Organization Name:OCEAN OPTICAL REDMOND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-556-0202
Mailing Address - Street 1:16128 NE 87TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3505
Mailing Address - Country:US
Mailing Address - Phone:425-556-0202
Mailing Address - Fax:425-307-0420
Practice Address - Street 1:16128 NE 87TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3505
Practice Address - Country:US
Practice Address - Phone:425-556-0202
Practice Address - Fax:425-307-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942582440OtherINDIVIDUAL NPI