Provider Demographics
NPI:1396819116
Name:SEATTLE EYECARE CENTER LLC
Entity Type:Organization
Organization Name:SEATTLE EYECARE CENTER LLC
Other - Org Name:2020 EYECARE CENTERS AUBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCOWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-682-2020
Mailing Address - Street 1:999 3RD AVE 2ND PLAZA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-682-2020
Mailing Address - Fax:206-332-0700
Practice Address - Street 1:999 3RD AVE
Practice Address - Street 2:2ND AVE PLAZA
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-4019
Practice Address - Country:US
Practice Address - Phone:206-682-2020
Practice Address - Fax:206-332-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8855914Medicare PIN