Provider Demographics
NPI:1619293321
Name:HARBOR OPHTHALMOLOGY
Entity Type:Organization
Organization Name:HARBOR OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:VILLANUEVA
Authorized Official - Last Name:ESTALILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-532-1930
Mailing Address - Street 1:1720 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4616
Mailing Address - Country:US
Mailing Address - Phone:360-532-1930
Mailing Address - Fax:360-532-1963
Practice Address - Street 1:1720 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4616
Practice Address - Country:US
Practice Address - Phone:360-532-1930
Practice Address - Fax:360-532-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 32016207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7063290Medicaid