Provider Demographics
NPI:1326618026
Name:MOUNT PILCHUCK EYECARE
Entity Type:Organization
Organization Name:MOUNT PILCHUCK EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMTERIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAJAKTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-310-9238
Mailing Address - Street 1:8713 64TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7704
Mailing Address - Country:US
Mailing Address - Phone:813-310-9238
Mailing Address - Fax:
Practice Address - Street 1:8713 64TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7704
Practice Address - Country:US
Practice Address - Phone:813-310-9238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty