Provider Demographics
NPI:1285023713
Name:WILLIAM PENTECOST, OD, PLLC
Entity Type:Organization
Organization Name:WILLIAM PENTECOST, OD, PLLC
Other - Org Name:EYE EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PENTECOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-619-2084
Mailing Address - Street 1:1317 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4021
Mailing Address - Country:US
Mailing Address - Phone:206-420-8328
Mailing Address - Fax:206-420-5368
Practice Address - Street 1:4854 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1742
Practice Address - Country:US
Practice Address - Phone:206-619-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60017743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty