Provider Demographics
NPI:1568579225
Name:CONTACT LENS CONSULTANTS NORTHWEST
Entity Type:Organization
Organization Name:CONTACT LENS CONSULTANTS NORTHWEST
Other - Org Name:FACTORIA EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:NIBLER
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:425-641-2020
Mailing Address - Street 1:4317 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1937
Mailing Address - Country:US
Mailing Address - Phone:425-641-2020
Mailing Address - Fax:425-641-7899
Practice Address - Street 1:4317 FACTORIA BLVD SE
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1937
Practice Address - Country:US
Practice Address - Phone:425-641-2020
Practice Address - Fax:425-641-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3162TX152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty