Provider Demographics
NPI:1346370483
Name:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Other - Org Name:KAISER PERMANENTE EYECARE/AUDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-630-1818
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:2921 NACHES AVE. SW
Practice Address - Street 2:GSE-B25-03
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-9009
Practice Address - Country:US
Practice Address - Phone:206-630-1600
Practice Address - Fax:206-630-1601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROUP HEALTH COOPERATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA478001461332H00000X
332H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332S00000XSuppliersHearing Aid Equipment