Provider Demographics
NPI:1225230634
Name:VALLEY EYE AND LASER CENTER, INC.,P.S.
Entity Type:Organization
Organization Name:VALLEY EYE AND LASER CENTER, INC.,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GAYLORD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-255-4250
Mailing Address - Street 1:4011 TALBOT RD S
Mailing Address - Street 2:#210
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5773
Mailing Address - Country:US
Mailing Address - Phone:425-255-4250
Mailing Address - Fax:425-271-3294
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:#210
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-255-4250
Practice Address - Fax:425-271-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600347898261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122294Medicaid
WA7122294Medicaid