Provider Demographics
NPI:1164575007
Name:COLLEGE PLACE OPTICAL CENTER INC.
Entity Type:Organization
Organization Name:COLLEGE PLACE OPTICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SWENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:425-774-3501
Mailing Address - Street 1:8325 212TH ST SW
Mailing Address - Street 2:#104
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-745-8025
Mailing Address - Fax:425-774-9642
Practice Address - Street 1:8325 212TH ST SW
Practice Address - Street 2:#104
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7435
Practice Address - Country:US
Practice Address - Phone:425-774-3501
Practice Address - Fax:425-774-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4087330001Medicare NSC