Provider Demographics
NPI:1235671587
Name:THIRD EYE IMAGING LLC
Entity Type:Organization
Organization Name:THIRD EYE IMAGING LLC
Other - Org Name:THIRD EYE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNEKE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R) RDMS
Authorized Official - Phone:509-833-0494
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-3046
Mailing Address - Country:US
Mailing Address - Phone:509-790-0060
Mailing Address - Fax:866-231-5852
Practice Address - Street 1:3405 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4732
Practice Address - Country:US
Practice Address - Phone:509-790-0060
Practice Address - Fax:866-231-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246XS1301X
131428246Z00000X
WART00006375247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty