Provider Demographics
NPI:1053637702
Name:NORTHWEST EYELID AND ORBITAL SPECIALISTS, P.S.
Entity Type:Organization
Organization Name:NORTHWEST EYELID AND ORBITAL SPECIALISTS, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-994-0428
Mailing Address - Street 1:626 S SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1325
Mailing Address - Country:US
Mailing Address - Phone:509-279-2176
Mailing Address - Fax:509-279-2941
Practice Address - Street 1:626 S SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1325
Practice Address - Country:US
Practice Address - Phone:509-279-2176
Practice Address - Fax:509-279-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60132733207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty