Provider Demographics
NPI:1558940387
Name:PACIFIC NORTHWEST RETINA PLLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST RETINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIRNBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-296-3837
Mailing Address - Street 1:1750 112TH AVE NE STE D050
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3779
Mailing Address - Country:US
Mailing Address - Phone:206-215-3850
Mailing Address - Fax:
Practice Address - Street 1:1750 112TH AVE NE STE D050
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3779
Practice Address - Country:US
Practice Address - Phone:206-215-3850
Practice Address - Fax:206-215-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty