Provider Demographics
NPI:1235320136
Name:DRS GREEN AND SUNDHOLM ENT INC PS
Entity Type:Organization
Organization Name:DRS GREEN AND SUNDHOLM ENT INC PS
Other - Org Name:BINYON OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-252-1231
Mailing Address - Street 1:2522 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201
Mailing Address - Country:US
Mailing Address - Phone:425-252-1231
Mailing Address - Fax:425-257-9881
Practice Address - Street 1:2522 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-252-1231
Practice Address - Fax:425-257-9881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS GREEN AND SUNDHOLM ENT INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020634Medicaid
WAU2143Medicare UPIN
1386735264Medicare PIN