Provider Demographics
NPI:1518955202
Name:SEATTLE VISION CLINIC INC
Entity Type:Organization
Organization Name:SEATTLE VISION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-623-1100
Mailing Address - Street 1:677 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2928
Mailing Address - Country:US
Mailing Address - Phone:206-623-1100
Mailing Address - Fax:206-624-0463
Practice Address - Street 1:677 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2928
Practice Address - Country:US
Practice Address - Phone:206-623-1100
Practice Address - Fax:206-624-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019925Medicaid
WA0025778OtherDEPT OF LABOR & INDUSTRIE
WA0246150001Medicare NSC
WA03351Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WAG217126500Medicare PIN