Provider Demographics
NPI:1497225882
Name:NORTHWEST EYE PROJECT PS
Entity Type:Organization
Organization Name:NORTHWEST EYE PROJECT PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEIL
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-859-1911
Mailing Address - Street 1:25022 104TH AVE SE STE D
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25022 104TH AVE SE STE D
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2822
Practice Address - Country:US
Practice Address - Phone:253-859-1911
Practice Address - Fax:253-859-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty