Provider Demographics
NPI:1417022484
Name:DR. WILLIAM BALOGH
Entity Type:Organization
Organization Name:DR. WILLIAM BALOGH
Other - Org Name:CENTER PLAZA VISION CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-839-1610
Mailing Address - Street 1:2016 S 320TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5453
Mailing Address - Country:US
Mailing Address - Phone:253-839-1610
Mailing Address - Fax:253-839-0755
Practice Address - Street 1:2016 S 320TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5453
Practice Address - Country:US
Practice Address - Phone:253-839-1610
Practice Address - Fax:253-839-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAO.D.00001030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA0006OtherNBN
WA3909OtherDAVIS
WABA3096OtherREGENCE
WA02781OtherSPECTERA
WA2052900Medicaid
WA212835OtherEYEMED
WAAETNAOther44132B
WA2052900Medicaid