Provider Demographics
NPI:1326194978
Name:OLYMPIC OPTICAL, INC., P.S.
Entity Type:Organization
Organization Name:OLYMPIC OPTICAL, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-301-4553
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:QUILCENE
Mailing Address - State:WA
Mailing Address - Zip Code:98376-0849
Mailing Address - Country:US
Mailing Address - Phone:360-301-4553
Mailing Address - Fax:
Practice Address - Street 1:1110 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3270
Practice Address - Country:US
Practice Address - Phone:360-683-1590
Practice Address - Fax:360-683-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001715332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7905458OtherAETNA
WAWA0751OtherNORTHWEST BENEFIT NETWORK
WA2020469Medicaid
WA1007880Medicaid
WA6010488OtherREGENCE BLUE SHIELD
WAP00096244OtherRAILROAD MEDICARE
WA2020469Medicaid