Provider Demographics
NPI:1477022002
Name:EVERGREEN FAMILY EYE CARE, PLLC
Entity Type:Organization
Organization Name:EVERGREEN FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:STURTEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-400-8068
Mailing Address - Street 1:1420 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5357
Mailing Address - Country:US
Mailing Address - Phone:617-645-5708
Mailing Address - Fax:
Practice Address - Street 1:17100 STATE ROUTE 507 SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7605
Practice Address - Country:US
Practice Address - Phone:360-400-8068
Practice Address - Fax:360-400-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty