Provider Demographics
NPI:1043586670
Name:EYE INSTITUTE OF OLYMPIA INC. P.S.
Entity Type:Organization
Organization Name:EYE INSTITUTE OF OLYMPIA INC. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEEDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-438-2207
Mailing Address - Street 1:300 LILLY RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5428
Mailing Address - Country:US
Mailing Address - Phone:360-438-2207
Mailing Address - Fax:360-438-2231
Practice Address - Street 1:300 LILLY RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5428
Practice Address - Country:US
Practice Address - Phone:360-438-2207
Practice Address - Fax:360-438-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023118207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7087539Medicaid
WA7087539Medicaid
WA001001633Medicare PIN
WAE72495Medicare UPIN