Provider Demographics
NPI:1497961924
Name:NORRGARD, ERIC SUNE (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SUNE
Last Name:NORRGARD
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17423 139TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8519
Mailing Address - Country:US
Mailing Address - Phone:425-485-2600
Mailing Address - Fax:
Practice Address - Street 1:17423 139TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8519
Practice Address - Country:US
Practice Address - Phone:425-485-2600
Practice Address - Fax:425-485-2526
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA835156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician