Provider Demographics
NPI:1235317637
Name:SPECIALTY EYECARE GROUP INC
Entity Type:Organization
Organization Name:SPECIALTY EYECARE GROUP INC
Other - Org Name:TOTEM LAKE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:KADING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-821-8900
Mailing Address - Street 1:11830 NE 128TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7202
Mailing Address - Country:US
Mailing Address - Phone:425-821-8900
Mailing Address - Fax:425-814-9782
Practice Address - Street 1:11830 NE 128TH ST STE 1
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7202
Practice Address - Country:US
Practice Address - Phone:425-821-8900
Practice Address - Fax:425-814-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty