Provider Demographics
NPI:1033427026
Name:EYE PHYSICIANS OF OLYMPIA INC PS
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF OLYMPIA INC PS
Other - Org Name:CLARUS EYE CENTRE DUPONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-923-4330
Mailing Address - Street 1:1200 STATION DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9804
Mailing Address - Country:US
Mailing Address - Phone:253-912-2020
Mailing Address - Fax:253-579-1153
Practice Address - Street 1:1200 STATION DR
Practice Address - Street 2:SUITE 150
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9804
Practice Address - Country:US
Practice Address - Phone:253-912-2020
Practice Address - Fax:253-579-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004005152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001045500Medicare PIN