Provider Demographics
NPI:1578999215
Name:KIRKLAND VISION CENTER, LLC
Entity Type:Organization
Organization Name:KIRKLAND VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-920-0677
Mailing Address - Street 1:13112 NE 70TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8571
Mailing Address - Country:US
Mailing Address - Phone:425-822-8253
Mailing Address - Fax:425-803-0346
Practice Address - Street 1:13112 NE 70TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8571
Practice Address - Country:US
Practice Address - Phone:425-822-8253
Practice Address - Fax:425-803-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3736TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty