Provider Demographics
NPI:1659426211
Name:PUGET SOUND EYE CARE
Entity Type:Organization
Organization Name:PUGET SOUND EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEROPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-526-5222
Mailing Address - Street 1:2501 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6909
Mailing Address - Country:US
Mailing Address - Phone:206-526-5222
Mailing Address - Fax:206-675-1460
Practice Address - Street 1:2501 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6909
Practice Address - Country:US
Practice Address - Phone:206-526-5222
Practice Address - Fax:206-675-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002087152W00000X
WAMD00014693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty