Provider Demographics
NPI:1346420791
Name:HAROLD G EVERETT, M.D, PLLC
Entity Type:Organization
Organization Name:HAROLD G EVERETT, M.D, PLLC
Other - Org Name:PRECISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:G
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-452-9708
Mailing Address - Street 1:1205 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4309
Mailing Address - Country:US
Mailing Address - Phone:360-452-9708
Mailing Address - Fax:360-457-7249
Practice Address - Street 1:519 EUREKA WAY
Practice Address - Street 2:SUITE #2
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-4309
Practice Address - Country:US
Practice Address - Phone:360-681-0570
Practice Address - Fax:360-457-7249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAROLD G EVERETT, M.D, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-13
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602258381174400000X
WABYSLIC00801332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5303380001Medicare NSC
WAGAB35487Medicare PIN