Provider Demographics
NPI:1629336847
Name:EYE AND CONTACT LENS CENTER PS
Entity Type:Organization
Organization Name:EYE AND CONTACT LENS CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GOLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-822-8204
Mailing Address - Street 1:601 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5422
Mailing Address - Country:US
Mailing Address - Phone:425-822-8204
Mailing Address - Fax:425-822-8001
Practice Address - Street 1:601 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5422
Practice Address - Country:US
Practice Address - Phone:425-822-8204
Practice Address - Fax:425-822-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA1818261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8908306Medicare PIN