Provider Demographics
NPI:1477801264
Name:REDMOND VISION CLINIC, PLLC
Entity Type:Organization
Organization Name:REDMOND VISION CLINIC, PLLC
Other - Org Name:REDMOND VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-885-1974
Mailing Address - Street 1:17634 NE UNION HILL RD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6096
Mailing Address - Country:US
Mailing Address - Phone:425-885-1974
Mailing Address - Fax:425-882-7818
Practice Address - Street 1:17634 NE UNION HILL RD UNIT 120
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-885-1974
Practice Address - Fax:425-882-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0004157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty