Provider Demographics
NPI:1518146422
Name:DR SUSAN COTTER & ASSOCIATES PC
Entity Type:Organization
Organization Name:DR SUSAN COTTER & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-513-9186
Mailing Address - Street 1:8601 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE #501
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5478
Mailing Address - Country:US
Mailing Address - Phone:425-513-9186
Mailing Address - Fax:
Practice Address - Street 1:8601 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE #501
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5478
Practice Address - Country:US
Practice Address - Phone:425-513-9186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1476TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021285Medicaid
WAGAB06136Medicare PIN
WA0601380001Medicare NSC